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HR 9393

Lower Costs, More Transparency Act of 2026

119th Congress Introduced by Brett Guthrie and 1 co-sponsor

Requires hospitals, labs, imaging, ASCs and health plans to publicly disclose pricing and cost-sharing info, with penalties for noncompliance starting Jan 1, 2028.

Introduced in House
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WeVote Research Nonpartisan
Bill Summary · HR 9393

Overview

  • Bill: HR 9393, Lower Costs, More Transparency Act of 2026
  • Session: 119th Congress
  • Purpose: Promote price transparency across the health care sector by requiring hospitals, imaging centers, ambulatory surgical centers, and certain laboratories to publicly disclose pricing and related information, with ongoing enforcement and penalties for noncompliance. The measure also extends price transparency requirements to health coverage (cost sharing) information for group health plans.

Key Provisions

1) Hospital Price Transparency (Medicare and Public Health Service Act)

  • Effective date: Beginning January 1, 2028.
  • Scope: Requires specified hospitals (hospitals, critical access hospitals, and rural emergency hospitals) that receive Medicare payments to publicly disclose pricing.
  • Public data to be published for each year:
    • All standard charges for items/services.
    • Prices in a consumer-friendly format for at least 300 shoppable services (including many CMS-specified shoppable services) and an indication for any services not furnished by the hospital.
    • Payer-specific negotiated charges with third-party payers (by payer and plan).
    • De-identified maximum and minimum negotiated charges for each item/service.
    • Type 2 national provider identifiers for hospital units.
    • An attestation of completeness and accuracy.
    • Link to charity care policy and pricing slides (where applicable).
  • Data format and accessibility:
    • Uniform, machine-readable format for standard charges; formats may align with CMS templates.
    • Updates to formats and data standards as determined by the Secretary.
  • Compliance and enforcement:
    • Monitoring, complaint analysis, audits, and additional information requests.
    • Civil monetary penalties for noncompliance, with scale based on bed count; daily penalties range from $300 (very small hospitals) up to $35 per bed per day (larger hospitals).
    • Corrective action plans, potential waivers/reductions (with exceptions for rural/underserved areas), and escalation pathways.
    • Enforcement can integrate with existing penalties under other federal authorities; penalties may be adjusted by rulemaking in subsequent years.
  • Public reporting:
    • Real-time-type public reporting on CMS website about compliance, notifications issued, penalties, and whether hospitals came into compliance, including details of waivers/reductions.

2) Public Health Service Act (PHSA) Amendments for Hospitals

  • Adds an identical hospital price transparency requirement under PHSA section 2718(f), with the same timeline (January 1, 2028) and enforcement framework.
  • Rule of construction clarifies that these amendments do not impede enforcement of other PHSA provisions.

3) Clinical Diagnostic Laboratory Test Price Transparency

  • Effective date: Beginning January 1, 2028.
  • Applies to applicable laboratories that receive payment under Medicare for specified clinical diagnostic tests.
  • Requirements:
    • Labs must publicly publish pricing information for each specified test on an internet site.
    • Data must be updated at least annually with an attestation of accuracy.
    • A uniform method/format must be established by the Secretary (CMS) to ensure usability, potentially mirroring CMS templates.
    • Prices must include ancillary services and indicate any additional charges (e.g., specimen collection).
    • Enforcement through notices, potential civil penalties ($300 per day) for noncompliance, with waivers/reductions and hardship carve-outs similar to hospital provisions.
    • Technical assistance to labs as practicable.

4) Imaging Price Transparency

  • Also effective January 1, 2028.
  • Requires imaging services providers/suppliers (except those already covered by other price data) to publish:
    • The discounted cash price or gross charge for each imaging service.
    • A uniform method/format for disclosure (machine-readable, CMS-like templates).
    • Annual updates and attestation of accuracy.
  • Enforcement includes notices, corrective action plans, civil penalties (up to $300 per day), waivers/reductions, hardship exemptions, and technical assistance.
  • Public reporting on CMS site about compliance and enforcement.

5) Ambulatory Surgical Center (ASC) Price Transparency

  • Effective January 1, 2028.
  • Requires ASCs to publish:
    • All standard charges and prices for shoppable services (CMS-listed) and ASC-selected services to achieve at least 300 shoppable services.
    • Indicate non-furnished CMS-listed services.
    • Attest completeness/accuracy.
    • Uniform data format and machine-readable publishing.
    • Monitoring, enforcement with daily penalties (up to $300/day), waivers/reductions for hardship, and potential escalation for persistent noncompliance.
    • Technical assistance.

6) Health Coverage Price Transparency (IRC and Cost Sharing)

  • Applies to group health plans; sunsets to plan years beginning on or after January 1, 2028.
  • For plan years before 2028, the Act preserves a pre-existing price comparison tool framework (with a sunset).
  • For plan years on/after 2028:
    • Plans must provide cost-sharing information upon request via self-service tools or other methods (paper or phone) at no cost.
    • Information to include:
    • In-network and maximum allowed amounts for services.
    • Estimated cost-sharing for the requested item/service.
    • Amounts already accumulated toward deductibles/out-of-pocket maximums.
    • Applicable limitations, prior authorization requirements, and any financial incentives tied to the service.
    • Drug pricing information for spread-pricing drugs, including pricing differentials and plain-language explanations.
    • Self-service tools must offer real-time responses and region/provider-specific options.
    • Penalties for noncompliance with civil monetary penalties, with waivers/reductions and hardship exemptions possible.
    • Compliance assistance and clarifications on non-duplication with other enforcement provisions.

Who Is Affected

  • Hospitals and hospital systems (including rural and critical access hospitals).
  • Ambulatory Surgical Centers.
  • Applicable imaging providers and suppliers (e.g., radiology, MRI, CT facilities).
  • Clinical laboratories that perform CMS-listed tests.
  • Health plans and group health plans offering self-funded or insured coverage under the IRC, including beneficiaries and participants who request cost-sharing information.

Timelines and Procedural Notes

  • Primary effective date for pricing transparency requirements: January 1, 2028.
  • Secretary of Health and Human Services (and CMS) to establish uniform methodologies and formats by January 1, 2028.
  • Real-time/publication metrics and enforcement data to begin public reporting on CMS websites starting January 1, 2028.
  • House committees: Energy and Commerce; Ways and Means; Education and Workforce will consider provisions as jurisdiction allows.

Potential Impacts

  • Increased price transparency across hospitals, labs, imaging centers, ASCs, and health plans.
  • Consumers and patients can compare prices and understand cost-sharing obligations more clearly.
  • Hospitals and providers face new compliance costs and ongoing penalties for noncompliance, but also potential reductions in administrative price-related disputes.
  • Payers (third-party payers) must disclose negotiated charges and maximum/minimum negotiated ranges.
  • The law emphasizes accessibility for individuals with limited English proficiency.

Notes: The bill contains detailed penalty schedules tied to bed counts and service types, with escalation and hardship carve-outs. It also contemplates future adjustments through Secretary-driven rulemaking.

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

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