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HR 9645

Health Care Price Certainty for All Americans Act

119th Congress Introduced by Jason Smith

HR 9645 would require hospitals, labs, imaging centers, and ASCs to publicly disclose standardized, machine-readable prices and price data, with consumer-friendly estimates and pen

Committee Consideration and Mark-up Session Held
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Bill Summary · HR 9645

Overview

  • Bill: HR 9645
  • Session: 119th Congress
  • Title: Health Care Price Certainty for All Americans Act
  • Purpose: Promote health care price transparency and price certainty for consumers by requiring public disclosure of charges and prices across hospitals, labs, imaging centers, and certain price transparency and cost-sharing information within health coverage.

Main purpose and intent

  • Establish comprehensive price transparency and price-clarity requirements to help consumers compare costs and make informed health care choices.
  • Extend price transparency to facilities in Medicare, other facilities receiving payment under Title XVIII, and to certain health coverage information under private plans (IRC-related provisions).
  • Create enforceable standards and penalties to ensure compliance, with a focus on shoppable services and price estimator tools.

Key provisions and changes

A. Hospitals (Medicare Part E, Title XVIII)

  • Effective: January 1, 2027 for specified hospitals.
  • Requirements:
    • Publicly disclose all standard charges for items and services (and for many CMS-specified shoppable services), plus payer-specific negotiated charges, discounted cash prices, and related price data.
    • Data must be published in a uniform method/format established by the Secretary, machine-readable for charges and consumer-friendly for prices.
    • Include links to charity care policies and indicate any uninsured/underinsured considerations.
    • Maintain data for at least 300 shoppable services (or all if fewer than 300) and provide price estimates via a price estimator tool if the hospital has one.
    • Hospitals with price estimator tools must be deemed compliant if the tool already provides the required price information.
  • Compliance and Enforcement:
    • Secretary monitors compliance, conducts audits, and can issue corrective action plans.
    • Civil penalties for noncompliance, structured by hospital size, with daily penalties up to specified amounts; potential increases in 2029 and beyond.
    • Public reporting on CMS sites about compliance and enforcement, including penalty details and waivers/reductions.
    • Provisions for waivers, rural/underserved area considerations, and case-by-case hardship exemptions.
  • Public accessibility:
    • Real-time or regular updates; enforcement and compliance data posted publicly.

B. Clinical Diagnostic Laboratories (Labs)

  • Effective: January 1, 2028.
  • Requirements:
    • Publicly disclose the discounted cash price (or gross charge if no discount) for specified clinical diagnostic tests.
    • Each lab must publish data in a uniform method/format and annually attest to data accuracy.
    • Include ancillary services pricing as part of test pricing.
  • Compliance and Enforcement:
    • Similar 30/90-day notification/corrective action plan process and civil penalties ($300 per day cap for noncompliance).
    • Penalty adjustments possible for 2029+; hardship waivers allowed; technical assistance provided.
  • Tracking and reporting:
    • Public posting of compliance status and enforcement actions.

C. Imaging Services (Certain Diagnostic Imaging)

  • Effective: January 1, 2028.
  • Requirements:
    • Providers must publish discounted cash prices for each CMS-specified shoppable imaging service, with standard charges and price data in uniform formats.
    • Data updated at least annually; annual attestation of data accuracy; charity care/linkage required where applicable.
    • Price estimator tool compliance deemed sufficient if the center maintains such a tool meeting defined standards.
  • Compliance and Enforcement:
    • Similar to labs: monitoring, corrective actions, penalties, waivers, and hardship provisions.
  • Public accessibility:
    • Data published on provider websites; standardized format and consumer usability emphasized.

D. Ambulatory Surgical Centers (ASCs)

  • Effective: January 1, 2028.
  • Requirements:
    • Publish standard charges for items/services and CMS-specified shoppable services; publish price data for at least 300 services, and use uniform formats.
    • Annual attestation; price data posted publicly; charity care information linked.
  • Price estimator tools:
    • If a price estimator tool exists, compliance can be achieved through the tool’s published data.
  • Compliance and Enforcement:
    • Mirrors hospital and lab enforcement structure; civil penalties for noncompliance; waivers possible for rural/underserved areas; technical assistance provided.

E. Price Transparency in Coverage (Private Plans)

  • Effective: Plan years beginning 2029.
  • Provisions:
    • Reforms to the Internal Revenue Code (IRC) to replace maintenance of the price comparison tool header with “Transparency in Coverage.”
    • Requires group health plans to publish:
    • Cost-sharing information on request (deductibles, copays, coinsurance, out-of-pocket accumulations, currency of cost-sharing, applicable limitations, prior authorizations, and other incentives or requirements).
    • In-network and out-of-network price data and estimates for items, services, and drugs, including negotiated rates, allowed amounts, and provider-specific payment data.
    • Information about bundled rates, pricing methodologies, and how payments differed over a plan year.
    • Quarterly public rate and payment information via machine-readable files, accessible without login credentials, with cross-plan comparability.
    • Summary data files for each plan year including mean/median rates, trends, network type, and bundled/capitated arrangements.
    • Self-service tools must be accessible and provide real-time responses; information must be easy to search and compare.
    • The plan must provide plain-language instructions for accessing data.
  • Cost-sharing transparency:
    • Plan must make cost-sharing information available to participants on request, with self-service tools or alternative disclosures (paper/phone/electronic) at no cost.
  • Publication format:
    • Data must be machine-readable, downloadable, and posted on widely accessible websites; quarterly updates required.

Who would be affected

  • Hospitals (including rural hospitals, critical access hospitals, and rural emergency hospitals) covered by Medicare Part A & B payments.
  • Specific laboratories that bill Medicare/Medicaid and perform targeted diagnostic tests.
  • Ambulatory Surgical Centers that receive Medicare/Medicaid payments for services.
  • Providers of certain imaging services that receive Medicare/Medicaid payments.
  • Group health plans and their insured/covered participants or beneficiaries, including self-insured arrangements.
  • Individual consumers with health plans who use price transparency tools and cost-sharing information.
  • Stakeholders, including hospital associations, patient advocacy groups, insurers, and health IT developers, who would interact with new reporting formats and tools.

Timeline and procedural aspects

  • 2027: Hospitals must begin compliance for price transparency.
  • 2028: Public posting requirements and uniform methods/formats required for hospitals, labs, imaging, and ASCs; implementation of price-estimator tools as applicable.
  • 2028 onward: Ongoing monitoring and enforcement actions begin; real-time public reporting of enforcement data.
  • 2029: Private plan provisions for cost-sharing transparency take effect; rate/payments reporting requirements for plans broadened; potential adjustments to civil penalties (per-day amounts) authorized by rulemaking.
  • Ongoing: Secretary may adjust enforcement mechanisms, waive penalties in hardship scenarios, provide technical assistance, and update formats to maintain usability and accessibility.

Notable details

  • Price data must be in dollar amounts and include diverse price data (gross charges, payer-specific negotiated charges, de-identified negotiated ranges, discounted cash price, and self-pay median prices when applicable).
  • Price estimator tools must meet specific accessibility standards (immediate price estimates, no mandatory accounts, broad accessibility, and clear disclosures).
  • Civil penalties are tiered by facility size and subject to potential increases post-2029; hardship and rural waivers are allowed with limits.
  • Accessibility improvements for non-English speakers are encouraged through rulemaking.
  • Public reporting requirements begin in 2028 for hospitals, labs, imaging, and ASCs; private plan data publication begins for plan years 2029+.

This bill would significantly expand price transparency requirements across hospitals, labs, imaging centers, ASCs, and private health coverage, with a strong emphasis on consumer-friendly formats, standardized data, and enforceable penalties for noncompliance.

Compiled from official sources — confirm details with the bill’s official record.

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