‘‘(1) IN GENERAL.—Each hospital’’; 
(2) by inserting ‘‘, in plain language without 
subscription and free of charge, in a consumer- 
friendly, machine-readable format,’’ after ‘‘a list’’; 
and 
(3) by adding at the end the following: ‘‘Begin-
ning January 1, 2024, each hospital shall include in 
its list of standard charges, along with such addi-
tional information as the Secretary may require with 
respect to such charges for purposes of promoting 
public awareness of hospital pricing in advance of 
receiving a hospital item or service, as applicable, 
the following: 
‘‘(A) A description of each item or service 
provided by the hospital, accompanied by, as 
applicable, the Current Procedural Terminology 
(CPT) code, the Healthcare Common Procedure 
Coding System (HCPCS) code, the Diagnosis 
Related Group (DRG), the National Drug Code 
(NDC), or other payer identifier used or ap-
proved by the Centers for Medicare & Medicaid 
Services. 
‘‘(B) The gross charge, expressed as a dol-
lar amount, for each such item or service, when 
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provided in, as applicable, the hospital inpatient 
setting and outpatient department setting. 
‘‘(C) Any current payer-specific negotiated 
charges, clearly associated with the name of the 
third party payer and plan and expressed as a 
dollar amount, that applies to each item or 
service when provided in, as applicable, the hos-
pital inpatient setting and outpatient depart-
ment setting. 
‘‘(D) The discounted cash price, expressed 
as a dollar amount, for each such item or serv-
ice when provided in, as applicable, the hospital 
inpatient setting and outpatient department 
setting. If the discounted cash price is a per-
centage of another value provided, the cal-
culated value must be entered as a dollar 
amount. If the discounted cash price equates to 
the gross charge, the gross charge shall be re- 
entered to indicate that no cash discount is 
available. 
‘‘(E) The average negotiated rate and ac-
quisition cost paid by the hospital for each drug 
or biological product— 
‘‘(i) for which payment would be made 
under part B of title XVIII of the Social 
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Security Act if the individual administered 
such drug or biological product were en-
rolled under such part B; and 
‘‘(ii) that is administered by the hos-
pital or an entity with a direct financial re-
lationship to the hospital during the pre-
vious year, 
which, in the case of such a drug or biological 
product that is first administered in the hos-
pital during the previous 12-month period, shall 
be included in such list of standard charges be-
ginning not later than 30 days after the date of 
such first administration. 
‘‘(2) DELIVERY METHODS AND USE.— 
‘‘(A) IN
GENERAL.—Each hospital shall 
make public the standard charges described in 
paragraph (1) for as many of the 70 Centers 
for Medicare & Medicaid Services-specified 
shoppable services that are provided by the hos-
pital, and as many additional hospital-selected 
shoppable services as may be necessary for a 
combined total of at least 300 shoppable serv-
ices, including the rate at which a hospital pro-
vides and bills for that shoppable service. If a 
hospital does not provide 300 shoppable services 
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in accordance with the previous sentence, the 
hospital shall make public the information spec-
ified under paragraph (1) for as many 
shoppable services as it provides. 
‘‘(B) DETERMINATION BY CMS.—With re-
spect to a year before 2025, a hospital shall be 
deemed by the Centers for Medicare & Medicaid 
Services to meet the requirements of subpara-
graph (A) if the hospital maintains an internet- 
based price estimator tool that meets the fol-
lowing requirements: 
‘‘(i) The tool provides estimates for as 
many of the 70 specified shoppable services 
that are provided by the hospital, and as 
many 
additional 
hospital-selected 
shoppable services as may be necessary for 
a combined total of at least 300 shoppable 
services. 
‘‘(ii) The tool allows health care con-
sumers to, at the time they use the tool, 
obtain an estimate of the amount they will 
be obligated to pay the hospital for the 
shoppable service. 
‘‘(iii) The tool is prominently dis-
played on the hospital’s website and easily 
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accessible to the public, without subscrip-
tion, fee, or having to submit personal 
identifying information (PII), and search-
able by service description, billing code, 
and payer. 
‘‘(3) UNIFORM
METHOD
AND
FORMAT.—Not 
later than January 1, 2025, the Secretary shall im-
plement a standard, uniform method and format for 
hospitals to use in order to satisfy the requirements 
of this subsection for disclosing directly to the public 
charge and price information. Such method and for-
mat may be similar to any template established by 
the Centers for Medicare & Medicaid Services as of 
the date of the enactment of this paragraph for re-
porting such information under this subsection and 
shall meet such standards as determined appropriate 
by the Secretary. 
‘‘(4) MONITORING OF PRICING INFORMATION.— 
The Secretary, in consultation with the Inspector 
General of the Department of Health and Human 
Services, shall, through notice and comment rule-
making, establish a process to regularly monitor the 
accuracy and validity of pricing information dis-
played by each hospital pursuant to paragraph (1). 
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‘‘(5) DEFINITIONS.—Notwithstanding any other 
provision of law, for the purpose of paragraphs (1) 
and (2): 
‘‘(A) DE-IDENTIFIED
MAXIMUM
NEGO-
TIATED CHARGE.—The term ‘de-identified max-
imum negotiated charge’ means the highest 
charge that a hospital has negotiated with all 
third party payers for an item or service. 
‘‘(B) DE-IDENTIFIED
MINIMUM
NEGO-
TIATED CHARGE.—The term ‘de-identified min-
imum negotiated charge’ means the lowest 
charge that a hospital has negotiated with all 
third party payers for an item or service. 
‘‘(C) 
DISCOUNTED
CASH
PRICE.—The 
term ‘discounted cash price’ means the charge 
that applies to an individual who pays cash, or 
cash equivalent, for a hospital item or service. 
Hospitals that do not offer self-pay discounts 
may display the hospital’s undiscounted gross 
charges as found in the hospital chargemaster. 
‘‘(D) GROSS
CHARGE.—The term ‘gross 
charge’ means the charge for an individual item 
or service that is reflected on a hospital’s 
chargemaster, absent any discounts. 
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‘‘(E) 
PAYER-SPECIFIC
NEGOTIATED 
CHARGE.—The term ‘payer-specific negotiated 
charge’ means the charge that a hospital has 
negotiated with a third party payer for an item 
or service. 
‘‘(F) SHOPPABLE
SERVICE.—The term 
‘shoppable service’ means a service that can be 
scheduled by a health care consumer in ad-
vance. 
‘‘(G) STANDARD
CHARGES.—The term 
‘standard charges’ means the regular rate es-
tablished by the hospital for an item or service, 
including both individual items and services and 
service packages, provided to a specific group of 
paying patients, including the gross charge, the 
payer-specific negotiated charge, the discounted 
cash price, the de-identified minimum nego-
tiated charge, the de-identified maximum nego-
tiated charge, and other rates determined by 
the Secretary. 
‘‘(H) THIRD
PARTY
PAYER.—The term 
‘third party payer’ means an entity that is, by 
statute, contract, or agreement, legally respon-
sible for payment of a claim for a health care 
item or service. 
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‘‘(6) ENFORCEMENT.— 
‘‘(A) IN GENERAL.—In the case of a hos-
pital that fails to provide the information re-
quired by this subsection— 
‘‘(i) the Secretary shall notify such 
hospital of such failure not later than 30 
days after the date on which the Secretary 
determines such failure exists; and 
‘‘(ii) not later than 90 days after the 
date of such notification, the hospital shall 
complete a corrective action plan to comply 
with such requirements. 
‘‘(B) CIVIL MONETARY PENALTY.— 
‘‘(i) IN GENERAL.—In addition to any 
other enforcement actions or penalties that 
may apply under subsection (b)(3) or an-
other provision of law, a hospital that has 
received a notification under subparagraph 
(A)(i) and fails to satisfy the requirement 
under subparagraph (A)(ii) or otherwise 
comply with the requirements of this sub-
section not later than 90 days after such 
notification, shall be subject to a civil mon-
etary penalty of an amount— 
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‘‘(I) in the case the hospital pro-
vides not more than 30 beds (as de-
termined 
under 
section 
180.90(c)(2)(ii)(D) of title 45, Code 
of Federal Regulations, as in effect on 
the date of the enactment of this 
paragraph), not to exceed $300 per 
day that the violation is ongoing as 
determined by the Secretary; and 
‘‘(II) in the case the hospital pro-
vides more than 30 beds (as so deter-
mined), equal to— 
‘‘(aa) subject to item (bb), 
$10 per bed per day that the vio-
lation is ongoing as determined 
by the Secretary, but for viola-
tions occurring before January 1, 
2024, not to exceed $5,500 per 
each such day; or 
‘‘(bb) in the case such hos-
pital has failed to satisfy the re-
quirement under subparagraph 
(A)(ii) or otherwise comply with 
the requirements of this sub-
section for any continuous 1-year 
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period beginning on or after Jan-
uary 1, 2024, and the amount 
otherwise imposed under item 
(aa) for such failure for such pe-
riod 
would 
be 
less 
than 
$5,000,000, an amount not less 
than $5,000,000. 
‘‘(ii) INCREASE
AUTHORITY.—In ap-
plying this subparagraph with respect to 
violations occurring in 2025 or a subse-
quent year, the Secretary may through no-
tice and comment rulemaking increase any 
dollar amount applied under this subpara-
graph by an amount specified by the Sec-
retary. 
‘‘(iii) APPLICATION OF CERTAIN PRO-
VISIONS.—The provisions of section 1128A 
of the Social Security Act (other than sub-
sections (a) and (b) of such section) shall 
apply to a civil monetary penalty imposed 
under clause (i) in the same manner as 
such provisions apply to a civil monetary 
penalty imposed under subsection (a) of 
such section.’’. 
(b) PUBLICATION OF LIST OF HOSPITALS.— 
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(1) LIST OF HOSPITALS.—Beginning not later 
than 90 days after the date of enactment of this 
Act, the Secretary of Health and Human Services 
(referred to in this section as the ‘‘Secretary’’) shall 
establish and maintain a publicly available list, on 
the website of the Centers for Medicare & Medicaid 
Services and updated in real time, of— 
(A) each hospital that— 
(i) is not in compliance with the hos-
pital price transparency rule implementing 
section 2718(e) of the Public Health Serv-
ice Act (42 U.S.C. 300gg–18(e)), and that, 
with respect to such noncompliance— 
(I) has been issued a civil mone-
tary penalty; 
(II) has received a warning no-
tice; or 
(III) has received a request for a 
corrective action plan; or 
(ii) has received any written commu-
nication by the Secretary regarding poten-
tial noncompliance with such hospital price 
transparency rule; and 
(B) each hospital that is in compliance 
with respect to such hospital price transparency 
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rule and has not received any written commu-
nication described in paragraph (1)(B). 
(2) FOIA REQUESTS.—Any penalty, notice, re-
quest, or other communication described in sub-
section (a) shall be subject to public disclosure, in 
full and without redaction, under section 552 of title 
21, United States Code, notwithstanding any exemp-
tions or exclusions otherwise available under such 
section 552. 
(3) REPORTS TO CONGRESS.—Not later than 1 
year after the date of enactment of this Act and 
each year thereafter, the Secretary of Health and 
Human Services shall submit to Congress, and make 
publicly available, a report that contains information 
regarding complaints of alleged violations of law and 
enforcement activities by the Secretary under the 
hospital price transparency rule implementing sec-
tion 2718(e) of the Public Health Service Act (42 
U.S.C. 300gg–18(e)). Such report shall be made 
available to the public on the website of the Centers 
for Medicare & Medicaid Services. Each such report 
shall include, with respect to the year involved— 
(A) the number of compliance and enforce-
ment inquiries opened by the Secretary pursu-
ant to such section; 
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(B) the number of notices of noncompli-
ance issued by the Secretary based on such in-
quiries; 
(C) the identity of each hospital entity that 
received a notice of noncompliance and the na-
ture of the failure giving rise to the Secretary’s 
determination of noncompliance; 
(D) the amount of civil monetary penalty 
assessed against the hospital entity; 
(E) whether the hospital entity subse-
quently corrected the noncompliance; and 
(F) an analysis of factors contributing to 
increasing health care costs. 
(4) GAO REPORT.—Not later than 1 year after 
the date of enactment of this Act, the Comptroller 
General of the United States shall submit to the 
Committee on Energy and Commerce of the House 
of Representatives and the Committee on Health, 
Education, Labor, and Pensions and the Committee 
on Finance of the Senate a report on the compliance 
and enforcement with the hospital price trans-
parency rule implementing section 2718(e) of the 
Public Health Service Act (42 U.S.C. 300gg–18(e)). 
The report shall include recommendations related 
to— 
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(A) improving price transparency to pa-
tients, employers, and the public; and 
(B) 
increased 
civil 
monetary 
penalty 
amounts to ensure compliance. 
(5) REQUEST
FOR
INFORMATION.—Not later 
than January 1, 2025, the Secretary of Health and 
Human Services shall issue a public request for in-
formation as to the best method through which hos-
pitals may be required to publish quality data (such 
as data required to be reported under the Medicare 
Hospital Compare program) alongside data required 
to be reported under section 2718(e) of the Public 
Health Service Act (42 U.S.C. 300gg–18(e)). 
SEC. 3. STRENGTHENING HEALTH INSURANCE TRANS-
PARENCY REQUIREMENTS. 
(a) 
COST
SHARING
TRANSPARENCY.—Section 
1311(e)(3)(C) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18031(e)(3)(C)) is amended— 
(1) by striking ‘‘The Exchange’’ and inserting 
the following: 
‘‘(i) IN GENERAL.—The Exchange’’; 
(2) in clause (i), as inserted by paragraph (1)— 
(A) by striking ‘‘participating provider’’ 
and inserting ‘‘provider’’; 
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(B) by inserting ‘‘shall include the infor-
mation specified in clause (ii) and’’ after ‘‘such 
information’’; 
(C) by striking ‘‘an Internet website’’ and 
inserting ‘‘a self-service tool that meets the re-
quirements of clause (iii)’’; and 
(D) by striking ‘‘and such other’’ and all 
that follows through the period and inserting 
‘‘or, at the option such individual, through a 
paper disclosure (provided at no cost to such in-
dividual) that meets such requirements as the 
Secretary may specify.’’; and 
(3) by adding at the end the following new 
clauses: 
‘‘(ii) SPECIFIED
INFORMATION.—For 
purposes of clause (i), the information 
specified in this clause is, with respect to 
an item or service for which benefits are 
available under a health plan furnished by 
a health care provider, the following: 
‘‘(I) If such provider is a partici-
pating provider with respect to such 
item or service, the in-network rate 
(as defined in subparagraph (F)) for 
such item or service. 
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‘‘(II) If such provider is not de-
scribed in subclause (I), the maximum 
amount the plan will recognize as pay-
ment for such item or service. 
‘‘(III) The amount of cost shar-
ing 
(including 
deductibles, 
copay-
ments, and coinsurance) that the indi-
vidual will incur for such item or serv-
ice (which, in the case such item or 
service is to be furnished by a pro-
vider described in subclause (II), shall 
be calculated using the maximum 
amount described in such subclause). 
‘‘(IV) The amount the individual 
has already accumulated with respect 
to any deductible or out of pocket 
maximum under the plan (broken 
down, in the case separate deductibles 
or maximums apply to separate indi-
viduals enrolled in the plan, by such 
separate deductibles or maximums, in 
addition to any cumulative deductible 
or maximum). 
‘‘(V) In the case such plan im-
poses any frequency or volume limita-
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tions with respect to such item or 
service (excluding medical necessity 
determinations), the amount that such 
individual has accrued towards such 
limitation with respect to such item or 
service. 
‘‘(VI) Any prior authorization, 
concurrent review, step therapy, fail 
first, or similar requirements applica-
ble to coverage of such item or service 
under such plan. 
‘‘(iii) SELF-SERVICE TOOL.—For pur-
poses of clause (i), a self-service tool estab-
lished by a health plan meets the require-
ments of this clause if such tool— 
‘‘(I) is based on an Internet 
website; 
‘‘(II) provides for real-time re-
sponses to requests described in such 
clause; 
‘‘(III) is updated in a manner 
such 
that 
information 
provided 
through such tool is timely and accu-
rate; 
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‘‘(IV) allows such a request to be 
made with respect to an item or serv-
ice furnished by— 
‘‘(aa) a specific provider 
that is a participating provider 
with respect to such item or serv-
ice; 
‘‘(bb) all providers that are 
participating providers with re-
spect to such plan and such item 
or service; or 
‘‘(cc) a provider that is not 
described in item (bb); and 
‘‘(V) provides that such a request 
may be made with respect to an item 
or service through use of the billing 
code for such item or service or 
through use of a descriptive term for 
such item or service. 
The Secretary may require such tool, as a 
condition of complying with subclause (V), 
to link multiple billing codes to a single de-
scriptive term if the Secretary determines 
that the billing codes to be so linked cor-
respond to items and services with no more 
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than a de minimis difference in patient ex-
perience in receiving such items and serv-
ices and cost sharing imposed under such 
plan for such items and services.’’. 
(b) DISCLOSURE OF ADDITIONAL INFORMATION.— 
Section 1311(e)(3) of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18031(e)(3)) is amended by add-
ing at the end the following new subparagraphs: 
‘‘(E) RATE
AND
PAYMENT
INFORMA-
TION.— 
‘‘(i) IN
GENERAL.—Not later than 
January 1, 2024, and every 3 months 
thereafter, each health plan shall submit to 
the Exchange, the Secretary, the State in-
surance commissioner, and make available 
to the public, the rate and payment infor-
mation described in clause (ii) in accord-
ance with clause (iii). 
‘‘(ii) RATE AND PAYMENT INFORMA-
TION DESCRIBED.—For purposes of clause 
(i), the rate and payment information de-
scribed in this clause is, with respect to a 
health plan, the following: 
‘‘(I) With respect to each item or 
service (other than a drug) for which 
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benefits are available under such plan, 
the in-network rate in effect as of the 
date of the submission of such infor-
mation with each provider (identified 
by national provider identifier) that is 
a participating provider with respect 
to such item or service, other than 
such a rate in effect with a provider 
that, during the 1-year period ending 
on such date, submitted fewer than 10 
claims for such item or service to such 
plan. 
‘‘(II) With respect to each drug 
(identified by national drug code) for 
which benefits are available under 
such plan, the average amount paid 
by such plan (net of rebates, dis-
counts, and price concessions) for 
such drug dispensed or administered 
during the 90-day period beginning 
180 days before such date of submis-
sion to each provider that was a par-
ticipating provider with respect to 
such drug, broken down by each such 
provider (identified by national pro-
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vider identifier), other than such an 
amount paid to a provider that, dur-
ing such period, submitted fewer than 
20 claims for such drug to such plan. 
‘‘(III) With respect to each item 
or service for which benefits are avail-
able under such plan, the amount 
billed, and the amount recognized by 
the plan, for each such item or service 
furnished during the 1-year period 
ending on such date by a provider 
that was not a participating provider 
with respect to such item or service, 
broken down by each such provider 
(identified by national provider identi-
fier), other than amounts billed by, 
and amounts recognized by a plan 
with respect to, a provider that, dur-
ing such period, submitted fewer than 
10 claims for such item or service to 
such plan. 
‘‘(iii) MANNER OF SUBMISSION.—Rate 
and payment information required to be 
submitted and made available under this 
subparagraph shall be so submitted and so 
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made available in 3 separate machine-read-
able files corresponding to the information 
described in each of subclauses (I) through 
(III) of clause (ii) that meet such require-
ments as specified by the Secretary 
through rulemaking. Such requirements 
shall ensure that such files are limited to 
an appropriate size, are made available in 
a widely-available format that allows for 
information contained in such files to be 
compared across health plans, and are ac-
cessible to individuals at no cost and with-
out the need to establish a user account or 
provider other credentials. 
‘‘(iv) USER GUIDE.—Each health plan 
shall make available to the public instruc-
tions written in plain language explaining 
how individuals may search for information 
described in clause (ii) in files submitted in 
accordance with clause (iii). 
‘‘(F) DEFINITIONS.—In this paragraph: 
‘‘(i) PARTICIPATING PROVIDER.—The 
term ‘participating provider’ has the mean-
ing given such term in section 2799A– 
1(a)(3) of the Public Health Service Act. 
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‘‘(ii) IN-NETWORK
RATE.—The term 
‘in-network rate’ means, with respect to a 
health plan and an item or service fur-
nished by a provider that is a participating 
provider with respect to such plan and 
item or service, the contracted rate in ef-
fect between such plan and such provider 
for such item or service.’’. 
(c) REPORTS.— 
(1) COMPLIANCE.—Not later than January 1, 
2025, the Comptroller General of the United States 
shall submit to Congress a report containing— 
(A) an analysis of health plan compliance 
with the amendments made by this section; 
(B) an analysis of enforcement of such 
amendments by the Secretaries of Health and 
Human Services, Labor, and the Treasury; 
(C) recommendations relating to improving 
such enforcement; and 
(D) recommendations relating to improving 
public disclosure, and public awareness, of in-
formation required to be made available by such 
plans pursuant to such amendments. 
(2) PRICES.—Not later than January 1, 2028, 
the Comptroller General of the United States shall 
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submit to Congress a report containing an assess-
ment of differences in negotiated prices (and any 
trends in such prices) in the private market be-
tween— 
(A) rural and urban areas; 
(B) the individual, small group, and large 
group markets; 
(C) 
consolidated 
and 
nonconsolidated 
health care provider areas (as specified by the 
Secretary); 
(D) nonprofit and for-profit hospitals; 
(E) nonprofit and for-profit insurers; and 
(F) insurers serving local or regional areas 
and insurers serving multistate or national 
areas. 
(d) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply beginning January 1, 2024. 
Æ 
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