S. 2355 — Patients Deserve Price Tags Act

This section requires each hospital to compile and publicly disclose all of its standard charges monthly, free of charge and without subscription, in a machine-readable spreadsheet format and a consumer-friendly format covering at least 300 shoppable services through December 31, 2026, and all shoppable services thereafter. It mandates disclosure of gross charges, discounted cash prices (which hospitals must accept as payment in full), payer-specific negotiated charges (including any underlying algorithms or formulas), and de-identified maximum and minimum negotiated charges; directs the Secretary to establish uniform methods and formats by January 1, 2026; prohibits price estimator tools from satisfying compliance; requires annual compliance monitoring; and mandates annual attestations of accuracy by the CEO, CFO, or equivalent senior official.

This section requires applicable laboratories, beginning July 1, 2027, to post on a public website plain-language descriptions with billing codes, gross charges, discounted cash prices (or minimum cash prices accepted from self-pay patients), payer-specific negotiated charges, and de-identified maximum and minimum negotiated charges for each specified clinical diagnostic laboratory test, updated monthly and including ancillary services. It directs the Secretary to establish a uniform machine-readable format by January 1, 2027, and authorizes civil monetary penalties of up to $300 per day for noncompliance.

This section requires providers and suppliers of specified imaging services, beginning July 1, 2027, to post on their websites a plain-language description with billing codes, gross charges, discounted cash prices (or minimum cash prices over the prior three years), payer-specific negotiated charges, and de-identified maximum and minimum negotiated charges for each service, updated annually. It directs the Secretary to establish a uniform machine-readable format by January 1, 2027, and authorizes civil monetary penalties of up to $300 per day for noncompliance.

This section requires specified ambulatory surgical centers, beginning July 1, 2027, to publicly post (free of charge and without subscription) machine-readable lists of standard charges and consumer-friendly price information for at least 300 shoppable services. The postings must include gross charges, discounted cash prices (which centers must accept as payment in full), payer-specific negotiated charges, de-identified maximum and minimum negotiated charges, and related identifiers. It directs the Secretary to establish uniform methods and formats by January 1, 2027, bars use of price estimator tools for compliance, and requires annual compliance monitoring with enforcement notifications.

This section requires health plans offered through Exchanges to furnish individuals with specified cost and coverage information for an item or service through a real-time self-service tool meeting detailed technical standards, or alternatively by paper or phone disclosure at no cost to the individual. It also requires each such plan to submit monthly rate and payment data—including in-network rates for items, services, and drugs identified by CPT, HCPCS, NDC, or similar codes, and historical net drug prices—to the Exchange, the Secretary, State insurance commissioners, and the public beginning January 1, 2027.

This section requires contracts between group health plans and covered service providers (including providers, networks, third-party administrators, and pharmacy benefit managers) to permit responsible plan fiduciaries access to all claims, encounter data, and supporting documentation to verify plan compliance and payment accuracy. Access must occur within 15 days without limits on volume, pricing terms for value-based or capitated arrangements, overpayments, audit scope, fees, or daily batch delivery; data must be provided in unmodified HIPAA-standard formats (ASC X12N 837, NCPDP, and 835) at no cost while complying with HIPAA privacy and security rules.

This section prohibits agreements between group health plans (or their sponsors, administrators, issuers, or business associates) and health plan service providers that limit or delay required disclosures, effective for plan years beginning 2 years after enactment. It requires such providers to furnish quarterly, at no cost, detailed information on contractual methodologies, reimbursement calculations, rebates, fees, remuneration, and alternative payment arrangements, subject to HIPAA privacy rules.

This section preserves state laws on health care price transparency for hospitals, clinical diagnostic laboratory tests, imaging services, and ambulatory surgical centers, except where those laws prevent application of requirements in sections 2 through 5. It does not affect group health plans under the Employee Retirement Income Security Act of 1974 or the application of section 514 of that Act.

This section requires group health plans and issuers to furnish participants, beneficiaries, or enrollees an itemized explanation of benefits within 45 days after any request for payment, for plan years beginning on or after January 1, 2026. The notice must state whether the provider is in-network, 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 limits, and the site of service. It also revises the required good-faith estimate for emergency services to include the same descriptions and codes.

This section requires health care providers and facilities to furnish patients a written itemized bill within 30 days after receiving final third-party payment for any health care item or service. The bill must list a plain-language description, all billing codes and modifiers, the price and billed amount for each item or service (or the binding bundled price), payments already made, language-assistance availability, a contact office authorized to adjust the bill, and charity-care policies. It prohibits collection actions unless the bill is provided and the amount does not exceed the applicable good faith estimate (except when the provider documents unforeseen medically necessary services), imposes penalties up to $10,000 per violation, and creates a presumption favoring the patient in disputes.