HR 8684
Transparency in Billing Act of 2026
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Bill overview
The Transparency in Billing Act of 2026 aims to improve transparency and accuracy in healthcare billing practices. It requires group health plans and health insurance issuers to only pay claims submitted by hospitals that have specific policies and procedures in place for billing. The bill also mandates the use of separate unique health identifiers for off-campus outpatient departments and establishes a process for reporting suspected billing violations, along with potential civil penalties for hospitals found in violation.
Key provisions
- Requires hospitals to use separate unique health identifiers for off-campus outpatient departments.
- Prohibits group health plans and insurers from paying claims submitted by hospitals lacking appropriate billing policies.
- Establishes a process for reporting suspected billing violations to the Secretary.
- Allows the Secretary to assess civil monetary penalties against hospitals for violations.
- Defines ‘off-campus outpatient department of a provider’ for the purpose of billing requirements.
- Requires hospitals to obtain a separate unique health identifier for the department where services are furnished.
- Mandates the Secretary to establish a reporting process within one year of enactment.
- Specifies penalty amounts based on hospital bed size.
Who is affected
- Group health plans
- Health insurance issuers
- Hospitals
- Patients
- Healthcare providers
Notable changes
Sponsors
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Primary sponsor
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119th CONGRESS — 2d Session
H. R. 8684
IN THE HOUSE OF REPRESENTATIVES
A BILL
To amend the Employee Retirement Income Security Act of 1974 to require group health plans and health insurance issuers offering group health insurance coverage to only pay claims submitted by hospitals that have in place policies and procedures to ensure accurate billing practices, and for other purposes.
This Act may be cited as the Transparency in Billing Act of 2026
.
Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1185 et seq.) is amended by adding at the end the following new section:
A group health plan or health insurance issuer offering group health insurance coverage may not pay a claim for items and services furnished to an individual at an off-campus outpatient department of a provider (as defined in section 901(c)) submitted by a hospital (as defined in section 1861(e) of the Social Security Act) unless such claim submitted by such hospital includes the separate unique health identifier for the department where items and services were furnished, in accordance with section 901.
The amendments made by this section shall take effect with respect to plan years beginning on or after January 1, 2027.
the claim for such items and services includes such separate unique health identifier for such department where such items and services were furnished.
Not later than one year after the date of enactment of this section, the Secretary shall establish a process under which a suspected violation of this section may be reported to such Secretary.
off-campus outpatient department of a providermeans a department of a provider (as defined in section 413.65 of title 42, Code of Federal Regulations, or any successor regulation) that is not located—
on the campus (as defined in such section) of such provider; or
within the distance (described in such definition of campus) from a remote location of a hospital facility (as defined in such section).
Section 502 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1132) is amended—
or (9)and inserting
(9), or (13); and
in subsection (c), by adding at the end the following new paragraph:
The Secretary may assess a civil monetary penalty against a hospital for a violation under section 901 in an amount—
in the case of a hospital with not more than 30 beds (as determined under section 180.90(c)(2)(ii)(D) of title 45, Code of Federal Regulations, as in effect on the date of the enactment of this paragraph), not to exceed $300 per day that the violation is ongoing, as determined by the Secretary; and
in the case of a hospital with more than 30 beds (as so determined), not to exceed $5,500 per each such day.
The Secretary of Labor shall implement the amendments made by this Act by rulemaking.