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CHECK Act of 2026
Introduced Jun 3, 2026 · Last action Jun 3, 2026 — Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
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Summary
This legislation is called the CHECK Act of 2026. It is being reviewed by a committee.
Full bill text
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9117 Introduced in House (IH)]
<DOC>
119th CONGRESS
2d Session
H. R. 9117
To promote the availability of certain healthcare information, and for
other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
June 3, 2026
Mr. Langworthy introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Education and Workforce, and Ways and Means, for a period to be
subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee
concerned
_______________________________________________________________________
A BILL
To promote the availability of certain healthcare information, 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 ``Clear Healthcare Expense Cost
Knowledge Act of 2026'' or the ``CHECK Act of 2026''.
SEC. 2. OVERSIGHT OF ADMINISTRATIVE SERVICE PROVIDERS.
(a) ERISA Amendments.--
(1) In general.--Subpart B of part 7 of subtitle B 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:
``SEC. 727. OVERSIGHT OF ADMINISTRATIVE SERVICE PROVIDERS.
``(a) In General.--For plan years beginning on or after the date
that is 2 years after the date of enactment of this section, no
agreement between a group health plan (as defined in section 733(a)),
the plan sponsor of such plan (as defined in section 3(16)(B)), the
plan administrator of such plan (as defined in section 3(16)(A)), or a
business associate of such plan (as defined in section 160.103 of title
45, Code of Federal Regulations), (or health insurance issuer offering
group health insurance coverage in connection with such a plan), and a
healthcare provider, network or association of providers, third-party
administrator, service provider offering access to a network of
providers, pharmacy benefit managers, or any other third party (each
referred to as a `health plan service provider') is permissible if such
agreement limits (or delays beyond the applicable reporting period
described in subsection (b)(1)) the disclosure of information to group
health plans in such a manner that prevents such plan, issuer, or
entity from providing the information described in subsection (b).
``(b) Required Disclosures.--
``(1) Contents and frequency.--With respect to plan years
beginning on or after the date that is 2 years after the date
of enactment of this section, not less frequently than
quarterly, a health plan service provider shall provide to the
group health plan or health insurance issuer the following
information at no cost to the group health plan or health
insurance issuer:
``(A) The information described in section
724(a)(1)(B).
``(B) Any contractual and subcontractual
calculation methodologies, pricing or fee schedules, or
other formulae used to determine reimbursement amounts
to providers and subcontractors, including
methodologies, schedules, fee structures, and any
applied adjustments or modifiers, with such information
provided in a manner sufficiently detailed to enable
the group health plan or health insurance issuer to
accurately assess, verify, and ensure compliance with
the terms of any contractual and subcontractual
agreement governing the reimbursement amounts.
``(C) The total amount received or expected to be
received by the health plan service provider or its
subcontractors in provider or supplier rebates, fees,
alternative discounts, and all other remuneration
including amounts held in escrow or variance accounts
that has been paid or is to be paid for claims incurred
and administrative services including data sales or
network payments.
``(D) The total amount paid or expected to be paid
by the health plan service provider or to
subcontractors in rebates, fees, contractual
arrangements, and all other remuneration that has been
paid or is expected to be paid for administrative and
other services.
``(E) All payment data and reconciliation
information related to alternative compensation
arrangements including accountable care organizations,
value-based programs, shared savings programs,
incentive compensation, bundled payments, capitation
arrangements, performance payments, and any other
reimbursement or payment models, where the group health
plan or health insurance issuer paid fees, incurred
obligations, or made payments in connection with the
group health plan related to such arrangements.
``(2) Privacy requirements.--
``(A) In general.--Health plan service providers
shall provide the information or data under paragraph
(1) consistent with the privacy, security, and breach
notification regulations at parts 160 and 164 of title
45, Code of Federal Regulations, promulgated under
subtitle F of the Health Insurance Portability and
Accountability Act of 1996, subtitle D of the Health
Information Technology for Clinical Health Act of 2009,
and section 1180 of the Social Security Act, and shall
restrict the use and disclosure of such information
according to such privacy, security, and breach
notification regulations. An entity that receives a
disclosure from a party in interest pursuant to
subparagraph (B) or (C) shall comply with the privacy
and security regulations promulgated under HIPAA.
``(B) Restrictions.--A group health plan shall
comply with section 164.504(f) of title 45, Code of
Federal Regulations (or a successor regulation), and a
plan sponsor shall act in accordance with the terms of
the agreement described in such section.
``(C) Rule of construction.--Nothing in this
section shall be construed to modify the requirements
for the creation, receipt, maintenance, or transmission
of protected health information under the HIPAA privacy
regulations (45 C.F.R. parts 160 and 164, subparts A
and E).
``(3) Disclosure and redisclosure.--
``(A) In general.--A group health plan receiving
information under paragraph (1) may disclose such
information only--
``(i) to the entity from which the
information was received or to that entity's
business associates or to the group health
plan's business associates as defined in
section 160.103 of title 45, Code of Federal
Regulations (or successor regulations); or
``(ii) as permitted by the HIPAA Privacy
Rule (45 C.F.R. parts 160 and 164, subparts A
and E).
``(B) Availability of information.--To the extent
the information required by this subsection is made
available to the health insurance issuer offering group
health insurance in connection with a group health
plan, the health insurance issuer shall make such
information available, at the same time, in the same
format, and at no cost, to the group health plan.
``(C) Failure to provide.--The obligation to
provide information pursuant to this subsection shall
exist notwithstanding the presence of any formal data-
sharing agreement between the parties. Failure to
provide the required information as specified shall
constitute a violation of this Act and the Secretary
shall initiate enforcement action under section 502
within 90 days of becoming aware of a violation of this
section, except that nothing in this section shall be
construed to limit the Secretary's existing authority
under the Act.
``(4) Data format standards.--All data and information
provided pursuant to this subsection shall comply with the
following standards:
``(A) All claims from a healthcare provider shall
be made to the group health plan in accordance with
transactions standards adopted under HIPAA, as follows:
``(i) Institutional, professional, and
dental claims and adjustments to these claims
shall be in ASC X12N 837 format, as transmitted
by the provider, or, in the case of paper
claims, converted to the ASC X12N 837
electronic format.
``(ii) Prescription drug claims shall be in
the National Council for Prescription Drug
Programs (NCPDP) format, as transmitted by the
provider, or in the case of paper claims,
converted to the NCPDP electronic format.
``(iii) Such data shall be provided at no
cost to the group health plan.
``(B) All claim payment (or EFT, electronic funds
transfer) and electronic remittance advice (ERA)
information sent by a health plan service provider
shall be provided to the group health plan or health
insurance issuer in the ASC X12N 835 format in
accordance with transaction standards adopted under
HIPAA, unmodified from the form in which it was
transmitted to the healthcare provider. Such
information shall be provided at no cost to the group
health plan or health insurance issuer.
``(C) The Secretary may modify the standards set
forth in this paragraph as necessary to align with any
changes adopted by the Secretary of Health and Human
Services pursuant to the authority provided under
section 1173 of the Social Security Act (42 U.S.C.
1320d-2).
``(c) Prohibited Contractual Provisions.--Any provision in an
agreement between a group health plan, the plan sponsor, the plan
administrator, or a business associate of such plan or a health
insurance issuer and a health plan service provider that unduly delays
or limits a group health plan's or health insurance issuer's access to
information described in this section or that restricts the format or
timing of the provision of such information in a manner that is
inconsistent with the requirements of this section shall be prohibited
and, if a group health plan or health insurance issuer enters into such
agreement, shall be deemed void as against public policy.
``(d) Penalties for Non-Compliance.--Any failure by a health plan
service provider to comply with the requirements of this section shall
result in the imposition of a civil penalty of $100,000 for each day
the violation continues, in addition to any other penalties prescribed
by law.
``(e) Regulations.--The Secretary shall implement this section
through notice and comment rulemaking in accordance with section 553 of
title 5, United States Code.''.
(2) Penalty.--
(A) In general.--Section 502(a) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C.
1132(a)) is amended by adding at the end the following
new paragraph:
``(14) The Secretary may assess a civil penalty against any
person of $100,000 per day for each violation by any person of
section 726.''.
(B) Technical amendment.--Paragraph (6) of section
502(a) of the Employee Retirement Income Security Act
of 1974 (29 U.S.C. 1132(a)) is amended by striking ``or
(9)'' and inserting it with the phrase ``(9), (13), or
(14)''.
(b) PHSA Amendments.--
(1) In general.--Part D of title XXVII of the Public Health
Service Act (42 U.S.C. 300gg-111 et seq.) is amended by adding
at the end the following:
``SEC. 2799A-12. OVERSIGHT OF ADMINISTRATIVE SERVICE PROVIDERS.
``(a) In General.--For plan years beginning on or after the date
that is 1 year after the date of enactment of this section, no
agreement between a group health plan that is a self-funded, non-
Federal governmental plan, as defined in section 2791(d)(8)(C) (42
U.S.C. 300gg-91(d)(8)(C)), and a healthcare provider, network or
association of providers, third-party administrator, service provider
offering access to a network of providers, pharmacy benefit managers,
or any other third party (each referred to in this section as a `health
plan service provider') is permissible if such agreement limits (or
delays beyond the applicable reporting period described in subsection
(b)(1)) the disclosure of information to group health plans in such a
manner that prevents such plan, issuer, or entity from providing the
information described in subsection (b).
``(b) Required Disclosures.--
``(1) Contents and frequency.--With respect to plan years
beginning on or after the date that is 1 year after the date of
enactment of this section, not less frequently than quarterly,
a health plan service provider shall provide to the group
health plan that is a self-funded, non-Federal governmental
plan the following information at no cost to the plan:
``(A) The information described in section 2799A-
9(a)(1)(B) (42 U.S.C. 300gg-119(a)(1)(B)).
``(B) Any contractual and subcontractual
calculation methodologies, pricing or fee schedules, or
other formulae used to determine reimbursement amounts
to providers and subcontractors, including
methodologies, schedules, fee structures, and any
applied adjustments or modifiers, with such information
provided in a manner sufficiently detailed to enable
the group health plan to accurately assess, verify, and
ensure compliance with the terms of any contractual and
subcontractual agreement governing the reimbursement
amounts.
``(C) The total amount received or expected to be
received by the health plan service provider or its
subcontractors in provider or supplier rebates, fees,
alternative discounts, and all other remuneration
including amounts held in escrow or variance accounts
that has been paid or is to be paid for claims incurred
and administrative services including data sales or
network payments.
``(D) The total amount paid or expected to be paid
by the health plan service provider or to
subcontractors in rebates, fees, contractual
arrangements, and all other remuneration that has been
paid or is expected to be paid for administrative and
other services.
``(E) All payment data and reconciliation
information related to alternative compensation
arrangements including accountable care organizations,
value-based programs, shared savings programs,
incentive compensation, bundled payments, capitation
arrangements, performance payments, and any other
reimbursement or payment models, where the group health
plan paid fees, incurred obligations, or made payments
in connection with the group health plan related to
such arrangements.
``(2) Privacy requirements.--
``(A) In general.--Health plan service providers
shall provide the information or data under paragraph
(1) consistent with the privacy, security, and breach
notification regulations at parts 160 and 164 of title
45, Code of Federal Regulations, promulgated under
subtitle F of the Health Insurance Portability and
Accountability Act of 1996, subtitle D of the Health
Information Technology for Clinical Health Act of 2009,
and section 1180 of the Social Security Act, and shall
restrict the use and disclosure of such information
according to such privacy, security, and breach
notification regulations. An entity that receives a
disclosure from a party in interest pursuant to
subparagraph (B) or (C) shall comply with the privacy
and security regulations promulgated under HIPAA.
``(B) Restrictions.--A group health plan that is a
self-funded, non-Federal governmental plan shall comply
with section 164.504(f) of title 45, Code of Federal
Regulations (or a successor regulation), and a plan
sponsor shall act in accordance with the terms of the
agreement described in such section.
``(C) Rule of construction.--Nothing in this
section shall be construed to modify the requirements
for the creation, receipt, maintenance, or transmission
of protected health information under the HIPAA privacy
regulations (45 C.F.R. parts 160 and 164, subparts A
and E).
``(3) Disclosure and redisclosure.--
``(A) In general.--A group health plan that is a
self-funded, non-Federal governmental plan receiving
information under paragraph (1) may disclose such
information only--
``(i) to the entity from which the
information was received or to that entity's
business associates as defined in section
160.103 of title 45, Code of Federal
Regulations (or successor regulations); or
``(ii) as permitted by the HIPAA Privacy
Rule (45 C.F.R. parts 160 and 164, subparts A
and E).
``(B) Rule of construction.--Nothing in this
section shall be construed to prevent a group health
plan that is a self-funded, non-Federal governmental
plan, or a health plan service provider providing
services with respect to such a plan, from placing
reasonable restrictions on the public disclosure of the
information described in paragraph (1), except that
such plan or entity may not restrict disclosure of such
information to the Department of Health and Human
Services, the Department of Labor, the Department of
the Treasury, or the Comptroller General of the United
States.
``(C) Failure to provide.--The obligation to
provide information pursuant to this subsection shall
exist notwithstanding the presence of any formal data-
sharing agreement between the parties. Failure to
provide the required information as specified shall
constitute a violation of this Act and the Secretary
shall initiate enforcement action under section 2723(b)
(42 U.S.C. 300gg-22(b)) within 90 days of becoming
aware of a violation of this section, except that
nothing in this section shall be construed to limit the
Secretary's existing authority under this Act.
``(4) Data format standards.--All data and information
provided pursuant to this subsection shall comply with the
following standards:
``(A) All claims from a healthcare provider shall
be made to the group health plan in accordance with
standards adopted under HIPAA at section 162.1101 of
title 45, Code of Federal Regulations, as follows:
``(i) Institutional, professional, and
dental claims and adjustments to these claims
shall be provided to the group health plan that
is a self-funded, non-Federal governmental plan
in the ASC X12N 837 format.
``(ii) Prescription drug claims shall be in
the National Council for Prescription Drug
Programs (NCPDP) format.
``(iii) The files shall be unmodified
copies of the files sent from the provider. In
the event that paper claims are sent by the
provider, they shall be converted to the
appropriate standard electronic format. Such
data shall be provided at no cost to the group
health plan.
``(B) All claim payment (or EFT, electronic funds
transfer) and electronic remittance advice (ERA)
information sent by a health plan service provider
shall be provided to the group health plan or health
insurance issuer in the ASC X12N 835 format, in
accordance with standards adopted under HIPAA at
section 162.1602 of title 45, Code of Federal
Regulations, unmodified from the form in which it was
transmitted to the healthcare provider. Such
information shall be provided at no cost to the group
health plan.
``(C) The Secretary may modify the standards set
forth in this paragraph as necessary to align with any
changes adopted by the Secretary pursuant to the
authority provided under section 1173 of the Social
Security Act (42 U.S.C. 1320d-2).
``(c) Prohibited Contractual Provisions.--Any provision in an
agreement that unduly delays or limits a group health plan that is a
self-funded, non-Federal governmental plan's access to information
described in this section or that restricts the format or timing of the
provision of such information in a manner that is inconsistent with the
requirements of this section shall be prohibited and, if a self-funded,
non-Federal governmental plan enters into such agreement, shall be
deemed void as against public policy.
``(d) Regulations.--The Secretary shall implement this section
through notice and comment rulemaking in accordance with section 553 of
title 5, United States Code.''.
(2) Penalty.--Section 2723(b) of the Public Health Service
Act (42 U.S.C. 300gg-22(b)) is amended by adding at the end the
following:
``(4) Enforcement authority relating to health plan service
providers.--Notwithstanding any provisions to the contrary, the
Secretary may assess a penalty against a health plan service
provider, as defined in section 2799A-12(a) (42 U.S.C. 300gg-
121(a)), of $100,000 per day for each violation of such
section, pursuant to substantially similar processes and
procedures as those set forth in section 2723(b)(2)(D) through
(G) (42 U.S.C. 300gg-121(b)(2)(D) through (G)).''.
SEC. 3. REQUIREMENT FOR EXPLANATION OF BENEFITS.
(a) PHSA Amendments.--
(1) Emergency services.--Section 2799A-1(f)(1)(C) of the
Public Health Service Act (42 U.S.C. 300gg-111(f)(1)(C)) is
amended to read as follows:
``(C) A good faith estimate of the amount the plan
or coverage is responsible for paying for items and
services included in the estimate described in
subparagraph (B), including a plain language
description of each item or service and all applicable
billing codes for each item or service, including
modifiers, using standard and commonly recognized
billing code sets that are clearly identified.''.
(2) Explanation of benefits.--Section 2799A-1 of the Public
Health Service Act (42 U.S.C. 300gg-111) is amended by adding
at the end the following:
``(g) Explanation of Benefits.--
``(1) In general.--For plan years beginning on or after
January 1, 2026, each group health plan, or a health insurance
issuer offering group or individual health insurance coverage
shall, within 45 days of receiving any request for payment for
an item or service under the plan, provide to the participant,
beneficiary, or enrollee (through mail or electronic means, as
requested by the participant, beneficiary, or enrollee) a
notification (in clear and understandable language and
utilizing substantially the same format as the advanced
explanation of benefits required by subsection (f) to enable
comparison) including the following:
``(A) Whether or not the provider or facility is a
participating provider or a participating facility with
respect to the plan or coverage with respect to the
furnishing of such item or service.
``(B) An itemized explanation of benefits that
includes the following:
``(i) A plain language description of each
item or service.
``(ii) All applicable billing codes for
each item or service, including modifiers,
using standard and commonly recognized billing
code sets that are clearly identified.
``(iii) The amount the plan or coverage is
responsible for paying for each item or
service.
``(iv) The amount of any cost-sharing for
which the participant, beneficiary, or enrollee
is responsible for each item or service (as of
the date of such notification).
``(v) The amount that the participant,
beneficiary, or enrollee has incurred toward
meeting the limit of the financial
responsibility (including with respect to
deductibles and out-of-pocket maximums) under
the plan or coverage (as of the date of such
notification).
``(vi) The site of each item or service.
``(2) Format.--If applicable, the notification described in
paragraph (1) may be provided in conjunction with, or as part
of, a notice of a claim determination or other communication
required by section 2719(a) (42 U.S.C. 300gg-19(a)), or
regulations thereunder.
``(h) Regulations.--The Secretary shall implement this section
through notice and comment rulemaking in accordance with section 553 of
title 5, United States Code.''.
(b) IRC Amendments.--
(1) Emergency services.--Section 9816(f)(1)(C) of the
Internal Revenue Code of 1986 is amended to read as follows:
``(C) A good faith estimate of the amount the plan
is responsible for paying for items and services
included in the estimate described in subparagraph (B),
including a plain language description of each item or
service and all applicable billing codes for each item
or service, including modifiers, using standard and
commonly recognized billing code sets that are clearly
identified.''.
(2) Explanation of benefits.--Section 9816 of the Internal
Revenue Code of 1986 is amended by adding at the end the
following:
``(g) Explanation of Benefits.--
``(1) In general.--For plan years beginning on or after
January 1, 2026, each group health plan shall, within 45 days
of receiving any request for payment for an item or service
under the plan, provide to the participant or beneficiary
(through mail or electronic means, as requested by the
participant or beneficiary) a notification (in clear and
understandable language and utilizing substantially the same
format as the advanced explanation of benefits required by
subsection (f) to enable comparison) including the following:
``(A) Whether or not the provider or facility is a
participating provider or a participating facility with
respect to the plan with respect to the furnishing of
such item or service.
``(B) An itemized explanation of benefits that
includes the following:
``(i) A plain language description of each
item or service.
``(ii) All applicable billing codes for
each item or service, including modifiers,
using standard and commonly recognized billing
code sets that are clearly identified.
``(iii) The amount the plan is responsible
for paying for each item or service.
``(iv) The amount of any cost-sharing for
which the participant or beneficiary is
responsible for each item or service (as of the
date of such notification).
``(v) The amount that the participant or
beneficiary has incurred toward meeting the
limit of the financial responsibility
(including with respect to deductibles and out-
of-pocket maximums) under the plan (as of the
date of such notification).
``(vi) The site of each item or service.
``(2) Format.--If applicable, the notification described in
paragraph (1) may be provided in conjunction with, or as part
of, a notice of a claim determination or other communication
required by section 503 of the Employee Retirement Income
Security Act of 1974 or regulations thereunder.
``(h) Regulations.--The Secretary shall implement this section
through notice and comment rulemaking in accordance with section 553 of
title 5, United States Code.''.
(c) ERISA Amendments.--
(1) Emergency services.--Section 716(f)(1)(C) of the
Employee Retirement Income Security Act of 1974 (29 U.S.C.
1185e(f)(1)(C)) is amended to read as follows:
``(C) A good faith estimate of the amount the
health plan is responsible for paying for items and
services included in the estimate described in
subparagraph (B), including a plain language
description of each item or service and all applicable
billing codes for each item or service, including
modifiers, using standard and commonly recognized
billing code sets that are clearly identified.''.
(2) Explanation of benefits.--Section 716 of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1185e) is
amended by adding at the end the following:
``(g) Explanation of Benefits.--
``(1) In general.--For plan years beginning on or after
January 1, 2026, each group health plan or health insurance
issuer offering group health insurance coverage shall, within
45 days of receiving any request for payment for an item or
service under the plan, provide to the participant or
beneficiary (through mail or electronic means, as requested by
the participant or beneficiary) a notification (in clear and
understandable language and utilizing substantially the same
format as the advanced explanation of benefits required by
subsection (f) to enable comparison) including the following:
``(A) Whether or not the provider or facility is a
participating provider or a participating facility with
respect to the plan or coverage with respect to the
furnishing of such item or service.
``(B) An itemized explanation of benefits that
includes the following:
``(i) A plain language description of each
item or service.
``(ii) All applicable billing codes for
each item or service, including modifiers,
using standard and commonly recognized billing
code sets that are clearly identified.
``(iii) The amount the plan or coverage is
responsible for paying for each item or
service.
``(iv) The amount of any cost-sharing for
which the participant or beneficiary is
responsible for each item or service (as of the
date of such notification).
``(v) The amount that the participant or
beneficiary has incurred toward meeting the
limit of the financial responsibility
(including with respect to deductibles and out-
of-pocket maximums) under the plan or coverage
(as of the date of such notification).
``(vi) The site of each item or service.
``(2) Format.--If applicable, the notification described in
paragraph (1) may be provided in conjunction with, or as part
of, a notice of a claim determination or other communication
required by section 503 or regulations thereunder.
``(h) Regulations.--The Secretary shall implement this section
through notice and comment rulemaking in accordance with section 553 of
title 5, United States Code.''.
SEC. 4. PROVISION OF ITEMIZED BILLS.
Part E of title XXVII of the Public Health Service Act (42 U.S.C.
300gg-131 et seq.) is amended by adding at the end the following:
``SEC. 2799B-10. PROVIDER REQUIREMENTS FOR ITEMIZED BILLS.
``(a) Requirements.--
``(1) Itemized bill and other information required.--
``(A) In general.--A healthcare provider or
healthcare facility that requests payment from an
individual after providing a healthcare item or service
to the patient shall include with such request a
written, itemized bill of the cost of each reasonably
expected item or service the healthcare provider or
healthcare facility provided to the individual,
including telehealth visits or visits by other
electronic means. The healthcare provider or healthcare
facility shall provide the itemized bill not later than
30 days after the healthcare provider or healthcare
facility received a final payment on the provided
service or supply from a third party.
``(B) Required information.--For each item or
service provided by the healthcare provider or facility
or for which the healthcare provider or facility is
billing the individual, the itemized bill must
include--
``(i) a plain language description of each
distinct healthcare item or service;
``(ii) all applicable billing codes for
each distinct healthcare item or service,
including modifiers, using standard and
commonly recognized billing code sets that are
clearly identified;
``(iii) the price and billed amount, if
different, of each distinct healthcare item or
service or if the provider or facility is
offering binding, all-in prices for bundled
items and services, the total binding price for
bundled items and services and billed amount;
``(iv) any payments made to the healthcare
provider or healthcare facility by or on behalf
of the individual (including payments by any
health plan or insurance) for any healthcare
item or service covered in the itemized bill;
``(v) information about the availability of
language-assistance services for individuals
with limited English proficiency (LEP);
``(vi) the identification of an office or
individual at the healthcare provider or
healthcare facility, including phone number and
email address, that shall be able to discuss
the specific details of the itemized statement
and be authorized to make appropriate changes
thereto; and
``(vii) information about the healthcare
provider's or healthcare facility's charity
care policies and instructions on how to apply
for charity care.
``(2) Collections actions.--
``(A) In general.--A healthcare provider or
healthcare facility shall not take any collections
actions against an individual--
``(i) for any provided healthcare item or
service unless the healthcare provider or
healthcare facility has complied with paragraph
(1); or
``(ii) with respect to any items or
services for which the amount appearing on an
itemized bill described above in paragraph (1)
exceeds the amount disclosed pursuant to
Federal healthcare price transparency
regulations, including part 180 of title 45,
Code of Federal Regulations, or provided in a
good faith estimate that complies with section
2799B-6 of this Act and section 149.610 of
title 45, Code of Federal Regulations, or
another good faith estimate provided by a
healthcare entity covered under this section
but not otherwise covered under such section
2799B-6 unless the provider or facility
documents that the additional items or services
were medically necessary due to unforeseen
complications or a patient-initiated change,
and could not reasonably have been anticipated.
``(B) Burden of proof.--The burden of proof under
subparagraph (A)(ii) shall rest with the provider, and
absent the documentation described in such
subparagraph, the good faith estimate shall be binding.
``(b) Failure To Comply.--
``(1) Penalties.--The Secretary shall impose penalties on
any healthcare provider or healthcare facility that fails to
comply with the requirements of this section in an amount not
to exceed $10,000 for each instance of failure to comply.
``(2) Presumption in favor of individual.--If a healthcare
provider or healthcare facility fails to comply with the
requirements of this section, the presumption shall be that
charges were substantially in excess of the good faith estimate
(as set forth in section 2799B-6) for the purpose of any
patient-provider dispute, including in accordance with section
2799B-7 and regulations promulgated thereunder.
``(c) Regulations.--The Secretary shall implement this section
through notice and comment rulemaking in accordance with section 553 of
title 5, United States Code.''.
<all>Official legislative text sourced from the public record (cached on CivicsHQ).
Official source
View the original bill, actions, and full legislative record on Congress.gov.
Status
In Committee
- 1Introduced
- 2Committee
- 3Floor
- 4Passed
- 5Signed
Timeline reflects current normalized status only. Full action history is not yet stored in the API.
Sponsors
Cosponsors
No cosponsors on record.
Votes
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