Sponsor
Nicholas A. Langworthy
Representative · R-NY
Representative · R-NY
The bill greatly increases price and billing transparency for patients and plan sponsors—reducing surprise bills and enabling oversight—but does so at the cost of substantial new compliance burdens, data‑security risks, and steep penalty exposure that may be passed on to consumers or strain smaller providers.
Patients and health plan enrollees (including uninsured people and Medicaid beneficiaries) receive clear, itemized EOBs and provider bills within firm timelines that show plain-language descriptions, billing codes, in-network status, site-of-service, and deductible/out-of-pocket progress — reducing surprise bills, enabling cost comparisons, and preventing collections when providers don't comply.
Group health plans and plan sponsors get quarterly, machine-readable claims, payment, rebate and pricing data at no cost, enabling better oversight, verification of payments/savings, and potential identification of overpayments that could lower plan costs over time.
Patients' protected health information remains subject to HIPAA and HITECH safeguards in the bill's disclosure and reporting requirements, which limits certain privacy risks from required data sharing.
Third-party administrators, PBMs, insurers, and providers will incur substantial new administrative and IT costs to produce standardized, itemized reports and machine-readable data — costs that are likely to be passed on to employers, taxpayers, or consumers through higher premiums or fees.
A very large civil monetary penalty (up to $100,000 per day) for certain data noncompliance creates risk of crippling fines for vendors or plans over technical or timing lapses, potentially disrupting plan operations, vendor relationships, and service continuity.
Broad, transaction-level machine-readable data collection and additional detailed billing disclosures increase the volume of sensitive payment and billing information transmitted and stored, raising the risk and consequences of data breaches or misuse if security is insufficient.
Based on analysis of 4 sections of legislative text.
Requires standardized disclosures of plan pricing/claims data, mandates itemized patient bills and expanded EOBs with billing codes, and creates civil penalties for noncompliance.
Official title: To promote the availability of certain healthcare information, and for other purposes.
Introduced June 3, 2026 by Nicholas A. Langworthy · Last progress June 3, 2026
Requires health plans, issuers, third‑party plan service providers, and health care providers to share detailed claims, pricing, rebate, fee, and billing‑code information with plans and patients in standardized formats, and to give clear, itemized bills and explanations of benefits. Creates strong enforcement tools including civil penalties and rulemaking deadlines, makes good‑faith estimates binding unless the provider documents unforeseeable changes, and limits certain contract terms that block access to data. Applies new disclosure rules across ERISA plans and most group insurance, adds an itemized patient billing requirement and timing limits on collections, and requires portable, code‑level line items in emergency good‑faith estimates and EOBs; authorizes civil penalties for noncompliance and directs federal agencies to issue implementing rules and enforcement procedures.