H.R. 10015 — Great American Healthcare Act

This section increases the annual health savings account contribution limit to the applicable dollar amount under section 402(g)(1)(B) (the 401(k) elective deferral limit) and allows additional catch-up contributions beginning at age 50 (from age 55). It eliminates the prior self-only and family coverage limits of $2,250 and $4,500, removes special rules for married individuals and Medicare eligibles, and applies the changes to taxable years beginning after enactment.

This section eliminates the requirement that an individual maintain high-deductible health plan coverage to contribute to a health savings account or claim the deduction for such contributions. It applies to taxable years beginning after the date of enactment.

This section expands qualified medical expenses eligible for tax-free distributions from health savings accounts to include amounts paid under direct primary care service arrangements that provide coverage restricted to primary care services in exchange for a fixed periodic fee. It also broadens the definition of eligible dependents to include any child of the account holder who has not attained age 27.

This section treats medical expenses incurred in the taxable year a health savings account is established—or in the preceding taxable year if the account is established before the tax return filing deadline—as qualified medical expenses eligible for tax-free HSA distributions. The rule applies to taxable years beginning after the date of enactment.

This section provides an exception to the excess contribution rules for health savings accounts, allowing distributions to correct administrative, clerical, or payroll errors if received by the individual on or before the due date of the tax return (including extensions) and accompanied by attributable net income, which must be included in gross income for the year received. The change takes effect on the date of enactment.

This section expands eligibility for health savings account rollovers upon the account holder’s death to include a child, parent, or grandparent in addition to a surviving spouse. It also treats an account acquired by a child for whom another taxpayer may claim a dependent deduction under section 151 as the child’s account.

This section allows health savings account distributions to cover qualified wellness expenses, treating them as medical care up to $100 per month for balances at or below $5,000, $150 for balances between $5,000 and $10,000, and $200 for balances above $10,000. Qualified expenses include healthy food meeting federal nutrition criteria, vitamins, dietary supplements, fitness facility memberships, exercise instruction, and related equipment such as wearable trackers, with specified limitations on apparel and facility types.

This section treats health savings accounts under section 223 of the Internal Revenue Code the same as individual retirement accounts under section 408 for purposes of bankruptcy exemptions in section 522 of title 11. The change applies to cases commencing after the date of enactment.

This section allows applicable large employers to satisfy the employer mandate by offering $450 monthly contributions to employees' health savings accounts, which counts as an offer of minimum essential coverage and prevents those employees from triggering the assessable payment. It also limits the tax exclusion for employer HSA contributions of at least $450 per month to employees enrolled in health care coverage for that month.

This section permits health flexible spending arrangements and health reimbursement arrangements to make qualified HSA rollover distributions of unused balances at the end of a plan year (or other times prescribed by the Secretary) via direct trustee-to-trustee transfer to a health savings account. The distributions are treated as rollover contributions under section 223(e)(5) and do not cause the arrangements to lose their tax treatment under sections 105 and 106. The rules apply to taxable years beginning after the date of enactment.

This section permits governmental entities and tax-exempt organizations to make qualified general contributions to health savings accounts for a specified class of beneficiaries—either all account holders or those residing in a designated geographic area with at least 5,000 account beneficiaries—and excludes the contributions from the beneficiaries’ gross income. The changes apply to taxable years beginning after the date of enactment.

This section allows trustees of health savings accounts to provide beneficiaries a URL or similar link enabling 501(c)(3) organizations to contribute directly to the accounts. Such contributions count as charitable deductions under section 170, up to $5,000 per organization per taxable year, for years beginning after enactment.

This section treats amounts paid by members of a health care sharing ministry for the sharing of medical expenses among members or for administrative fees as payments for medical care under the health savings account rules of section 223. The change applies to taxable years beginning after the date of enactment.

This section permits distributions of up to $5,000 from a health savings account to a Trump account for an eligible individual without regard to the deduction limits under section 223(b). It treats such distributions as exempt contributions to the Trump account. The changes apply to distributions made in taxable years beginning after the date of enactment.

This section permits a tax-free direct trustee-to-trustee transfer of the entire balance of a health savings account to a Trump account upon the death of the account beneficiary. It treats the transferred amount as an exempt contribution to the Trump account and applies to taxable years beginning after the date of enactment.

This section deems any health marketplace pool meeting specified requirements to be an employer under ERISA for offering group health plans or group health insurance coverage, including plans that cover only prescription or nonprescription drugs. The pool must form in good faith to create a risk pool, offer coverage to all members at rates that may vary by individual (subject to nondiscrimination rules), provide the same coverage to all members, and allow drug-only coverage.

This section expands the definition of employee organization under ERISA to include any member of a health marketplace pool meeting section 736(b) requirements. It provides that membership in such a pool does not by itself cause a person to be a fiduciary with respect to the group health plan or group health insurance coverage offered by the pool. It excludes from the definition of multiple employer welfare arrangement any group health plan or coverage (including plans offering only prescription or nonprescription drugs) offered by such a pool.

This section expands hospital price transparency requirements. Each hospital must compile and post monthly, free of charge and in machine-readable format, its gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified maximum and minimum negotiated charges for every item and service, using plain-language descriptions and standard billing codes. Hospitals must also post prices for at least 300 shoppable services through December 31, 2027, and all shoppable services thereafter. The Secretary must establish uniform posting methods and formats by January 1, 2027, conduct annual compliance reviews, and require annual attestations by a senior hospital official. Price estimator tools do not satisfy these requirements, and hospitals must accept the discounted cash price as payment in full.

This section requires applicable laboratories to post on a public website, beginning July 1, 2028, and update monthly, the gross charge, discounted cash price, payer-specific negotiated charges, and de-identified maximum and minimum negotiated charges for each specified clinical diagnostic laboratory test, including ancillary services such as specimen collection. It directs the Secretary to establish a uniform machine-readable format by January 1, 2028, and authorizes civil monetary penalties of up to $300 per day for noncompliance.

This section requires providers and suppliers of specified imaging services, other than those already subject to hospital price transparency rules, to post on a public website beginning July 1, 2028, a plain-language description with billing codes, gross charges, discounted cash prices (or minimum cash prices from the prior three years), payer-specific negotiated charges (including any algorithms or formulas), and de-identified maximum and minimum negotiated charges. Providers must accept the posted cash price as payment in full. It directs the Secretary to establish a uniform machine-readable format by January 1, 2028, and authorizes civil monetary penalties of up to $300 per day for noncompliance.

This section requires specified ambulatory surgical centers, beginning July 1, 2028, to publish machine-readable lists of standard charges (including gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified maximum and minimum charges) and consumer-friendly price information for at least 300 shoppable services. It directs the Secretary to establish uniform methods and formats by January 1, 2028, prohibits deemed compliance through price estimator tools, and requires annual compliance monitoring with enforcement notifications within 30 days of detected violations.

This section expands transparency requirements for health plans offered through American Health Benefit Exchanges. It requires plans to provide specified cost and coverage information—including in-network rates, out-of-network maximum allowed amounts, cost-sharing, deductible accumulations, frequency limitations, and prior authorization rules—through a real-time self-service tool (or paper or phone disclosure at no cost) rather than a website. It also requires monthly public disclosure, beginning January 1, 2028, of in-network rates by provider and historical net drug prices.

This section requires contracts between group health plans and covered service providers (including providers, networks, and third-party administrators) to grant plan fiduciaries access to all claims, encounter data, and supporting documentation to verify payments and compliance. Contracts may not impose delays beyond 15 days, volume limits, restrictions on pricing terms for value-based or capitated arrangements, overpayment disclosures, audit rights, or daily batch access, and must deliver data in unmodified HIPAA-standard formats (ASC X12N 837, NCPDP, and 835) at no cost while preserving existing privacy rules.

This section prohibits agreements between group health plans, plan sponsors, administrators, or health insurance issuers and health plan service providers that limit or delay disclosure of required information. It mandates that, for plan years beginning two years after enactment, such providers furnish quarterly at no cost the information in section 724(a)(1)(B), contractual reimbursement methodologies and fee schedules, total rebates and remuneration received or paid, and all payment data on alternative compensation arrangements, subject to HIPAA privacy and security rules.

This section limits federal preemption of state health care price transparency laws to cases of direct conflict. It preserves state requirements or prohibitions on price transparency for hospitals, clinical diagnostic laboratory tests, imaging services, and ambulatory surgical centers, except where they prevent application of sections 302 through 305, and clarifies that the provisions do not affect group health plans under the Employee Retirement Income Security Act of 1974.

This section requires group health plans and health insurance issuers, for plan years beginning on or after January 1, 2027, to provide participants, beneficiaries, or enrollees an itemized explanation of benefits within 45 days of any payment request. The notice must state whether the provider or facility participates in the plan, include plain-language descriptions and billing codes for each item or service, the plan’s payment responsibility, applicable cost-sharing, amounts applied toward deductibles and out-of-pocket maximums, and the site of service. It also revises the good faith estimate for emergency services to require the same billing code details.

This section requires health care providers and facilities to furnish patients with a written itemized bill within 30 days after receiving final third-party payment. The bill must list plain-language descriptions, billing codes and modifiers, prices or bundled amounts, payments received, language-assistance availability, a contact for disputes, and charity care policies. Providers may not initiate collections unless they have complied or document that excess charges above a good faith estimate were medically necessary due to unforeseen complications. The Secretary must impose penalties up to $10,000 per violation and apply a presumption favoring the patient in disputes.

This section removes the maximum fair price from the calculation of Part B payments for selected drugs under the average sales price plus 6 percent methodology. It requires manufacturers of selected drugs with a maximum fair price in effect to pay quarterly rebates to the Federal Supplementary Medical Insurance Trust Fund equal to the difference between the ASP+6 and MFP+6 payment and coinsurance amounts for units furnished under Part B during each calendar quarter beginning on or after the initial price applicability period. It sets beneficiary coinsurance at 20 percent of the MFP+6 payment amount for such drugs and applies existing civil money penalties for noncompliance.

This section establishes a list of expanded-access prescription drugs, designated by the Secretary of Health and Human Services based on safety data and low risk for pharmacy settings, such as certain antibiotics, antivirals, hormonal therapies, and chronic condition maintenance drugs. It authorizes dispensing and administration of these drugs by covered individuals—including pharmacists, advanced practice registered nurses, physician assistants, and other designated professionals—after patient assessment under Secretary-issued protocols, requires implementing regulations within 120 days, preempts conflicting state requirements except where states explicitly opt out, and directs a report to Congress within 2 years on implementation and state opt-outs.

This section requires government-sponsored health coverage programs to cover expanded-access prescription drugs administered by covered individuals to program beneficiaries. It preempts state laws restricting the licensure or scope of practice of covered individuals who administer such drugs.

This section repeals paragraph (12) of section 19(b) of the Federal Reserve Act. It requires any supplemental reserve authorized under subparagraph (A) to be maintained by Federal Reserve banks in an Earnings Participation Account that receives earnings each calendar quarter at a rate not exceeding the securities portfolio rate earned by the Federal Reserve System in the prior quarter. It repeals section 201 of the Financial Services Regulatory Relief Act of 2006.