Sponsors (2)
The bill increases billing transparency and strengthens enforcement to protect patients and reduce surprise charges, but does so at the cost of added compliance, potential fines, and administrative burdens that could strain hospitals (especially small/rural providers), delay roll‑out, and raise costs for patients or taxpayers.
Insured patients and employers: billing must include standardized department‑level identifiers, which should reduce incorrect facility fees and surprise outpatient billing.
Health insurers and plan administrators: standardized department identifiers improve claims-processing accuracy and support better audits/fraud detection.
Patients and the public: the Secretary can seek civil penalties and the law strengthens financial incentives for hospital compliance, improving enforcement of patient-protection rules.
Hospitals (especially smaller or rural systems): must upgrade billing/IT systems to report department‑level identifiers, imposing compliance costs that could raise prices or premiums.
Insured individuals and patients with chronic conditions: if hospitals fail to include the required identifier claims may be delayed or denied, triggering balance-billing disputes and payment hassles.
Patients (particularly in affected communities) and hospitals: large hospitals face substantial daily fines for violations, which could lead to service reductions, scaling back of outpatient offerings, or closures that reduce access to care.
Based on analysis of 5 sections of legislative text.
Requires department‑level unique identifiers on off‑campus hospital outpatient claims before group plans/issuers will pay and creates per‑day civil penalties for noncompliant hospitals.
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
Requires group health plans and issuers to reject hospital claims for services furnished at off‑campus outpatient departments unless the claim includes a unique identifier for the specific department where services were provided, and creates civil penalties for hospitals that fail to provide that identifier. Directs the Department of Labor to write rules to implement the changes and adds new ERISA headings to codify ‘‘honest billing’’ requirements. Sets per‑day civil monetary penalties capped differently for small hospitals (up to $300/day) and larger hospitals (up to $5,500/day). The billing requirement becomes effective for plan years beginning on or after January 1, 2027, and rulemaking is required to implement the law.