Transparent PRICE Act

This bill strengthens hospital and health insurance price transparency requirements. It amends existing law to require hospitals to publish detailed standard charges and shoppable service prices in a consumer-friendly format, and requires health plans to provide cost estimates and submit rate and payment information to the public.

Sec. 2, Hospital price transparency requirements: Hospitals must publish, free of charge and without subscription, a single machine-readable file of standard charges and a plain-language list of at least 300 shoppable services. The list must include gross charges, payer-specific negotiated charges, de-identified maximum and minimum negotiated charges, and discounted cash prices. Hospitals must update these lists at least annually. For years before 2025, hospitals may use an internet-based price estimator tool instead. By January 1, 2025, the Secretary of Health and Human Services must implement a standard format for disclosure. The Secretary must monitor pricing accuracy. Enforcement includes a corrective action plan and civil monetary penalties for noncompliance, with penalties up to $300 per day for small hospitals and $10 per bed per day for larger hospitals, with a minimum $5 million penalty for violations lasting over a year after January 1, 2024. The Secretary must publish a list of noncompliant hospitals and report to Congress annually on enforcement. The Government Accountability Office must report on compliance and recommend improvements.

Sec. 3, Health insurance transparency requirements: Health plans offered through Exchanges must provide a self-service tool that gives real-time estimates of in-network rates, out-of-network maximum allowed amounts, cost-sharing amounts, deductible and out-of-pocket accumulations, frequency limits, and prior authorization requirements. By January 1, 2025, and every three months thereafter, plans must submit to the Exchange and make public machine-readable files containing in-network rates by provider, average drug payments net of rebates, and out-of-network billed and allowed amounts. Plans must also provide a plain-language user guide. The Comptroller General must report on compliance by 2025 and on price differences by 2028. The amendments take effect January 1, 2025, and do not affect the existing Transparency in Coverage rule.