Sponsors (20)
The bill greatly increases price and billing transparency and strengthens patient protections (estimates, itemized bills, cash‑pay rights, data for plan oversight) but does so at the cost of substantial compliance, IT, privacy, and legal burdens—especially for smaller or rural providers—which may raise costs or disrupt access unless implementation carefully mitigates those burdens.
Patients (insured, uninsured, low-income and chronic-condition patients) receive standardized, timely, itemized EOBs and provider bills showing services, codes, plan payments, patient cost‑sharing, and progress toward deductibles/out‑of‑pocket limits, and are protected from collections until required itemized bills are provided.
Consumers (including uninsured and cash‑pay patients) gain broad price transparency—monthly, machine‑readable disclosures of hospital, lab, imaging, and ASC prices and payer‑negotiated rates—and the ability for cash‑pay patients to pay published discounted/minimum cash prices as payment in full.
Members and patients get clearer advance cost estimates and visibility into remaining deductibles/out‑of‑pocket maximums, plus a 'hold‑harmless' protection when estimates understate final charges, helping avoid unexpected bills for planned care.
Hospitals, providers, labs, ASCs, insurers, PBMs and plan service vendors face substantial new administrative, IT, legal, and reporting costs to compile, standardize, and publish detailed price, contract, and claims data—costs that are likely to be passed on to patients, employers, or taxpayers.
Small, rural, and safety‑net providers, labs, and ASCs may struggle to meet technical and timing requirements (machine‑readable files, 30‑day itemized bills, daily/annual updates), risking heavy penalties, cash‑flow problems, or reduced local access to services.
Expanded access to and sharing of PHI without individual authorization for plan administration increases privacy and autonomy risks—if safeguards fail this could enable improper profiling or unwanted secondary uses of health data.
Based on analysis of 11 sections of legislative text.
Creates broad item-level price transparency, EOB and billing rules, required machine-readable price files, enhanced plan access to claims/PHI, and penalties for noncompliance.
Introduced July 17, 2025 by Roger Wayne Marshall · Last progress July 17, 2025
Requires broad, detailed health care price transparency and stronger patient billing rules: plans, insurers, hospitals, laboratories, imaging providers, ambulatory surgical centers, and many other health care entities must publish itemized prices, billing codes, and consumer-friendly explanations in machine-readable and consumer-facing formats. Patients must receive timely explanation-of-benefits notices and itemized bills before collection actions; plans gain more access to claims and supporting data (with privacy safeguards). The bill creates civil penalties and requires agencies to issue standards and formats, with staggered effective dates (some rules start Jan 1, 2026; many publishing and data rules begin Jan 1 or July 1, 2027; other reporting timelines begin 1–2 years after enactment).