Sponsors (2)
The bill strengthens billing transparency and enforcement—reducing surprise bills and improving claims accuracy—but imposes compliance and enforcement costs that may strain hospitals (especially small/rural providers), risk access reductions, and delay implementation while rulemaking proceeds.
Insured patients and employers will face fewer incorrect facility fees and surprise bills because hospitals must report department‑level identifiers for off‑campus outpatient care, improving billing transparency.
Health insurers and plan administrators will get more standardized department identifiers, improving claims-processing accuracy, audits, and fraud detection.
Patients and the public gain stronger enforcement and accountability because the Secretary can bring civil actions and collect penalties from noncompliant hospitals.
Hospitals (especially larger systems) must upgrade billing and IT systems to capture and report department‑level identifiers, imposing compliance costs that could be passed on to patients via higher prices or to employers via higher premiums.
Smaller and rural hospitals may struggle with implementation costs and IT changes, increasing administrative burden and risking reduced access to timely outpatient services in rural communities.
Large hospitals face substantial potential daily fines (up to $5,500/day) for violations, which could increase operating costs and, if sustained, lead some hospitals to scale back services or close, reducing access to care.
Based on analysis of 5 sections of legislative text.
Requires a unique department identifier on claims for off‑campus outpatient hospital services before group plans/issuers may pay them and authorizes daily penalties for noncompliant hospitals.
Requires group health plans and group health insurance issuers to reject or not pay hospital claims for services furnished at off‑campus outpatient departments unless the claim includes a separate, unique identifier for the specific department where services were provided. Adds new ERISA headings for "Honest billing" and directs the Department of Labor to implement the changes by rulemaking, and it gives the Secretary authority to assess daily civil monetary penalties on hospitals that fail to supply the required department‑level identifier, capped by hospital size. The billing requirement becomes effective for plan years beginning on or after January 1, 2027.
Official title: To amend the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance 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.
Introduced May 7, 2026 by Virginia Ann Foxx · Last progress May 7, 2026