Health Care Prices Revealed and Information to Consumers Explained Transparency Act

This bill amends the Public Health Service Act to strengthen and expand price transparency requirements for hospitals, clinical diagnostic laboratories, imaging service providers, ambulatory surgical centers, and health plans. It also increases group health plan access to health data and clarifies that state laws are not superseded unless they conflict with the bill's provisions.

Sec. 2, Strengthening hospital price transparency requirements: Hospitals must make public, free of charge, all standard charges for each item and service, including gross charges, discounted cash prices, and payer-specific negotiated charges. They must also provide consumer-friendly pricing information for at least 300 shoppable services, expanding to all shoppable services after December 31, 2024. The discounted cash price must be accepted as payment in full from any patient choosing to pay cash.

Sec. 3, Increasing price transparency of clinical diagnostic laboratory tests under the Medicare program: Beginning January 1, 2025, applicable laboratories must publicly disclose on a website, updated at least annually, plain language descriptions, billing codes, gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified maximum and minimum negotiated charges for each specified clinical diagnostic laboratory test. The discounted cash price must be accepted as payment in full from any patient choosing to pay cash.

Sec. 4, Imaging transparency: Beginning January 1, 2025, providers and suppliers of specified imaging services (except those already covered by hospital transparency rules) must publicly disclose on a website, updated at least annually, the same types of pricing information required for clinical diagnostic laboratory tests, including gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified maximum and minimum negotiated charges. The discounted cash price must be accepted as payment in full from any patient choosing to pay cash.

Sec. 5, Ambulatory surgical center price transparency requirements: Beginning January 1, 2025, specified ambulatory surgical centers must make public, free of charge, a machine-readable list of standard charges and consumer-friendly pricing information for at least 300 shoppable services. Required information includes gross charges, discounted cash prices, and payer-specific negotiated charges. The discounted cash price must be accepted as payment in full from any patient choosing to pay cash.

Sec. 6, Strengthening health coverage transparency requirements: Health plans offered through Exchanges must provide a self-service tool on a website that gives real-time, accurate information on in-network rates, maximum allowed amounts, cost-sharing amounts, deductible and out-of-pocket accumulations, frequency or volume limitations, and prior authorization or similar requirements. Members are held harmless for any difference between the tool's estimate and the amount ultimately billed.

Sec. 7, Increasing group health plan access to health data: Contracts between group health plans and covered service providers (such as healthcare providers, networks, third-party administrators, and pharmacy benefit managers) must allow the plan access to all claims and encounter information and supporting documentation. Contracts cannot unreasonably limit or delay access, limit disclosure of pricing terms for value-based or capitated payment arrangements, or limit the plan's right to select an auditor or request action on suspect claims. Information must be provided in compliance with HIPAA privacy and security rules and conform to specified data standards.

Sec. 8, Preemption only in event of conflict: The provisions of sections 2 through 5 do not supersede state law requirements related to health care price transparency unless the state law prevents the application of a requirement in those sections. This section does not affect health plans established under ERISA.