Transparency in Billing Act of 2026

This bill amends the Employee Retirement Income Security Act of 1974 (ERISA) to require group health plans and health insurance issuers to only pay claims from hospitals that follow honest billing practices for off-campus outpatient departments, and establishes penalties for violations.

Sec. 2, Honest billing requirements: Group health plans and health insurance issuers may not pay a claim for items and services provided at an off-campus outpatient department of a provider unless the hospital's claim includes a separate unique health identifier for that department, as required by new section 901. This takes effect for plan years starting on or after January 1, 2027.

Sec. 3, Regulation of honest billing: A hospital may not submit a claim to a group health plan or issuer, nor hold an individual liable, for items and services at an off-campus outpatient department unless the hospital obtains a separate unique health identifier for that department and includes it on the claim. The Secretary of Labor must establish a process for reporting suspected violations within one year of enactment. An off-campus outpatient department is defined as a department not located on the hospital's campus or within a certain distance from a remote hospital facility.

Sec. 4, Enforcement: The Secretary of Labor may assess civil monetary penalties against a hospital for violating section 901. For hospitals with 30 or fewer beds, the penalty is up to $300 per day the violation continues; for hospitals with more than 30 beds, the penalty is up to $5,500 per day.

Sec. 5, Implementation: The Secretary of Labor shall implement the amendments made by this Act through rulemaking.