A BILL 
To amend the Employee Retirement Income Security Act 
of 1974 to require group health plans and health insur-
ance issuers offering group health insurance coverage 
to only pay claims submitted by hospitals that have 
in place policies and procedures to ensure accurate billing 
practices, and for other purposes. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Transparency in Billing 
Act of 2023’’. 
SEC. 2. HONEST BILLING REQUIREMENTS. 
(a) IN GENERAL.—Subpart B of part 7 of subtitle B 
of title I of the Employee Retirement Income Security Act 
of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at 
the end the following new section: 
‘‘SEC. 726. HONEST BILLING REQUIREMENTS. 
‘‘A group health plan or health insurance issuer offer-
ing group health insurance coverage may not pay a claim 
for items and services furnished to an individual at an off- 
campus outpatient department of a provider (as defined in 
section 901(c)) submitted by a hospital (as defined in sec-
tion 1861(e) of the Social Security Act) unless such claim 
submitted by such hospital includes the separate unique 
health identifier for the department where items and serv-
ices were furnished, in accordance with section 901.’’. 
(b) CLERICAL AMENDMENT.—The table of contents of 
the Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1001 note) is amended by adding after the item re-
lating to section 725 the following: 
‘‘Sec. 726. Honest billing requirements.’’. 
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(c) EFFECTIVE DATE.—The amendments made by this 
section shall take effect with respect to plan years beginning 
on or after January 1, 2024. 
SEC. 3. REGULATION OF HONEST BILLING. 
(a) IN GENERAL.—Subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1021 
et seq.) is amended by adding at the end the following new 
part: 
‘‘PART 9—BILLING REQUIREMENTS WITH RE-
SPECT TO GROUP HEALTH PLANS AND COV-
ERAGE 
‘‘SEC. 901. HONEST BILLING REQUIREMENTS. 
‘‘(a) IN GENERAL.—A hospital may not, with respect 
to items and services furnished to an individual at an off- 
campus outpatient department of a provider, submit a 
claim for such items and services to a group health plan 
or health insurance issuer, and may not hold such indi-
vidual liable for such items and services, unless— 
‘‘(1) such hospital obtains a separate unique 
health identifier established for such department pur-
suant to section 1173(b) of the Social Security Act; 
and 
‘‘(2) the claim for such items and services in-
cludes such separate unique health identifier for such 
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department where such items and services were fur-
nished. 
‘‘(b) PROCESS FOR REPORTING SUSPECTED VIOLA-
TIONS.—Not later than one year after the date of enactment 
of this section, the Secretary shall establish a process under 
which a suspected violation of this section may be reported 
to such Secretary. 
‘‘(c) OFF-CAMPUS OUTPATIENT DEPARTMENT OF A 
PROVIDER DEFINED.—For purposes of this paragraph, the 
term ‘off-campus outpatient department of a provider’ 
means a department of a provider (as defined in section 
413.65 of title 42, Code of Federal Regulations, or any suc-
cessor regulation) that is not located— 
‘‘(1) on the campus (as defined in such section) 
of such provider; or 
‘‘(2) within the distance (described in such defi-
nition of campus) from a remote location of a hos-
pital facility (as defined in such section).’’. 
(b) CLERICAL AMENDMENT.—The table of contents of 
the Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1001 note) is amended by inserting after the item 
relating to section 804 the following new item: 
‘‘PART 9—BILLING REQUIREMENTS WITH RESPECT TO GROUP HEALTH PLANS 
AND COVERAGE 
‘‘Sec. 901. Honest billing requirements.’’. 
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SEC. 4. ENFORCEMENT. 
Section 502 of the Employee Retirement Income Secu-
rity Act of 1974 (29 U.S.C. 1132) is amended— 
(1) in subsection (a)(6), by striking ‘‘or (9)’’ and 
inserting ‘‘(9), or (13)’’; and 
(2) in subsection (c), by adding at the end the 
following new paragraph: 
‘‘(13) The Secretary may assess a civil monetary 
penalty against a hospital for a violation under sec-
tion 901 in an amount— 
‘‘(A) in the case of a hospital with not more 
than 30 beds (as determined under section 
180.90(c)(2)(ii)(D) of title 45, Code of Federal 
Regulations, as in effect on the date of the enact-
ment of this paragraph), not to exceed $300 per 
day that the violation is ongoing, as determined 
by the Secretary; and 
‘‘(B) in the case of a hospital with more 
than 30 beds (as so determined), not to exceed 
$5,500 per each such day.’’. 
SEC. 5. IMPLEMENTATION. 
The Secretary of Labor shall implement the amend-
ments made by this Act by rulemaking. 
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Union Calendar No. 208 
118TH CONGRESS 
1ST SESSION 
H. R. 4509 
[Report No. 118–258] 
A BILL 
To amend the Employee Retirement Income Secu-
rity Act of 1974 to require group health plans 
and health insurance issuers offering group 
health insurance coverage to only pay claims sub-
mitted by hospitals that have in place policies 
and procedures to ensure accurate billing prac-
tices, and for other purposes. 
NOVEMBER 1, 2023 
Reported with an amendment, committed to the Com-
mittee of the Whole House on the State of the Union, 
and ordered to be printed 
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