This bill significantly expands healthcare price transparency requirements for various providers and health plans. It mandates that hospitals publicly disclose all standard charges, including gross, discounted cash, and payer-specific negotiated rates, for all items and services in a uniform, machine-readable format. Hospitals must also provide consumer-friendly pricing for at least 300 shoppable services, increasing to all shoppable services by 2027, with senior officials attesting to the accuracy of these disclosures.

The legislation extends similar transparency obligations to clinical diagnostic laboratories and imaging service providers, requiring them to publicly post detailed pricing information for specified tests and services. These disclosures, effective July 2027, must include plain language descriptions, billing codes, gross charges, discounted cash prices, and payer-specific negotiated rates, also in a standardized, machine-readable format. Ambulatory surgical centers (ASCs) with hospital ownership interests are similarly required to disclose standard charges and prices for shoppable services.

To ensure compliance, the bill establishes robust enforcement mechanisms, including civil monetary penalties for hospitals that fail to meet transparency requirements, with fines tiered by bed count and increasing for persistent non-compliance. Laboratories, imaging providers, and ASCs also face daily civil monetary penalties for non-compliance. The Secretary of Health and Human Services is tasked with establishing uniform methods and formats for these disclosures and monitoring compliance.

Beyond providers, the bill strengthens health coverage transparency requirements for health plans. It mandates the creation of real-time, internet-based self-service tools allowing individuals to determine their out-of-pocket costs for specific items and services, including in-network rates, maximum allowed amounts for out-of-network care, and accumulated deductibles. Plans must also publicly disclose detailed rate and payment information, including negotiated rates with providers and historical net drug prices, in machine-readable files monthly.

The legislation also significantly increases group health plans' access to health data from administrative service providers like pharmacy benefit managers (PBMs) and third-party administrators (TPAs). It voids contractual provisions that limit or delay access to claims and encounter data, payment documentation, or pricing terms, requiring quarterly disclosure of detailed financial information, including rebates and alternative compensation arrangements. Non-compliant service providers face substantial civil monetary penalties of $10,000 per day.

Finally, the bill enhances consumer understanding of medical bills. It requires health plans and insurers to provide an itemized Explanation of Benefits (EOB) within 45 days of a payment request, detailing services, billing codes, plan payments, and patient cost-sharing. Healthcare providers and facilities must also furnish itemized bills to individuals within 30 days of final payment, including plain language descriptions, billing codes, prices, and charity care information. Providers are prohibited from collection actions if these billing requirements are not met or if charges exceed disclosed estimates, with the burden of proof on the provider.