Transparency in Billing Act of 2026

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8684 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                                H. R. 8684

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.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                              May 7, 2026

    Ms. Foxx (for herself and Mr. Scott of Virginia) introduced the
 following bill; which was referred to the Committee on Education and
                               Workforce

_______________________________________________________________________

                                 A BILL

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.

    Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Transparency in Billing Act of
2026''.

SEC. 2. HONEST BILLING REQUIREMENTS.

    (a) In General.--Subpart B of part 7 of subtitle B of title I of
the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et
seq.) is amended by adding at the end the following new section:

``SEC. 727. HONEST BILLING REQUIREMENTS.

    ``A group health plan or health insurance issuer offering group
health insurance coverage may not pay a claim for items and services
furnished to an individual at an off-campus outpatient department of a
provider (as defined in section 901(c)) submitted by a hospital (as
defined in section 1861(e) of the Social Security Act) unless such
claim submitted by such hospital includes the separate unique health
identifier for the department where items and services were furnished,
in accordance with section 901.''.
    (b) Clerical Amendment.--The table of contents of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1001 note) is amended
by adding after the item relating to section 726 the following:

``Sec. 727. Honest billing requirements.''.
    (c) Effective Date.--The amendments made by this section shall take
effect with respect to plan years beginning on or after January 1,
2027.

SEC. 3. REGULATION OF HONEST BILLING.

    (a) In General.--Subtitle B of title I of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1021 et seq.) is amended by
adding at the end the following new part:

 ``PART 9--BILLING REQUIREMENTS WITH RESPECT TO GROUP HEALTH PLANS AND
                                COVERAGE

``SEC. 901. HONEST BILLING REQUIREMENTS.

    ``(a) In General.--A hospital may not, with respect to items and
services furnished to an individual at an off-campus outpatient
department of a provider, submit a claim for such items and services to
a group health plan or health insurance issuer, and may not hold such
individual liable for such items and services, unless--
            ``(1) such hospital obtains a separate unique health
        identifier established for such department pursuant to section
        1173(b) of the Social Security Act; and
            ``(2) the claim for such items and services includes such
        separate unique health identifier for such department where
        such items and services were furnished.
    ``(b) Process for Reporting Suspected Violations.--Not later than
one year after the date of enactment of this section, the Secretary
shall establish a process under which a suspected violation of this
section may be reported to such Secretary.
    ``(c) Off-Campus Outpatient Department of a Provider Defined.--For
purposes of this paragraph, the term `off-campus outpatient department
of a provider' means a department of a provider (as defined in section
413.65 of title 42, Code of Federal Regulations, or any successor
regulation) that is not located--
            ``(1) on the campus (as defined in such section) of such
        provider; or
            ``(2) within the distance (described in such definition of
        campus) from a remote location of a hospital facility (as
        defined in such section).''.
    (b) Clerical Amendment.--The table of contents of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1001 note) is amended
by inserting after the item relating to section 804 the following new
item:

 ``Part 9--Billing Requirements With Respect to Group Health Plans and
                                Coverage

``Sec. 901. Honest billing requirements.''.

SEC. 4. ENFORCEMENT.

    Section 502 of the Employee Retirement Income Security Act of 1974
(29 U.S.C. 1132) is amended--
            (1) in subsection (a)(6), by striking ``or (9)'' and
        inserting ``(9), or (13)''; and
            (2) in subsection (c), by adding at the end the following
        new paragraph:
            ``(13) The Secretary may assess a civil monetary penalty
        against a hospital for a violation under section 901 in an
        amount--
                    ``(A) in the case of a hospital with not more than
                30 beds (as determined 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
                    ``(B) in the case of a hospital with more than 30
                beds (as so determined), not to exceed $5,500 per each
                such day.''.

SEC. 5. IMPLEMENTATION.

    The Secretary of Labor shall implement the amendments made by this
Act by rulemaking.
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