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HR 8684

Transparency in Billing Act of 2026

119th Congress Introduced by Virginia Foxx and 1 co-sponsor

The act requires off-campus outpatient department claims to include a separate department health identifier to be paid, with penalties for noncompliance and rulemaking to implement

Introduced in House
0
WeVote Research Nonpartisan
Bill Summary · HR 8684

Summary of HR 8684 – Transparency in Billing Act of 2026

Purpose and intent

  • Introduces “Honest Billing Requirements” to ensure that group health plans and health insurance issuers offering group coverage pay only for hospital claims that comply with specific billing practices.
  • Aims to reduce improper or opaque billing for off-campus outpatient department services and promote accurate billing through standardized identifiers.

Key provisions and changes

  • Honest Billing Requirements (Section 727)

    • Group health plans and issuers may not pay claims for items and services furnished at an off-campus outpatient department of a provider unless the hospital’s claim includes the separate, unique health identifier for the specific department, as required by a related provision (section 901).
    • Adds this requirement to the Employee Retirement Income Security Act of 1974 (ERISA).

  • Structural additions to ERISA (Section 2 and Section 3)

    • Creates a new formal section (Section 727) within ERISA detailing the honest billing requirements and the necessary health identifiers.
    • Adds a new Part 9 to ERISA, titled “Billing Requirements With Respect to Group Health Plans and Coverage,” with Section 901 outlining the honest billing standards for off-campus outpatient departments.

  • Enforcement and penalties (Section 4)

    • Amends ERISA Section 502 to include a new civil monetary penalty authority.
    • Penalties for a hospital violation of Section 901:
    • Hospitals with 30 beds or fewer: up to $300 per day for ongoing violations.
    • Hospitals with more than 30 beds: up to $5,500 per day for ongoing violations.
    • The Department is empowered to assess these penalties upon enforcement.

  • Implementation (Section 5)

    • The Secretary of Labor is directed to implement the amendments through rulemaking.

  • Effective date

    • The honest billing requirements take effect for plan years beginning on or after January 1, 2027.

Affected parties

  • Hospitals and off-campus outpatient departments

    • Hospitals must have and submit the separate unique health identifier for the department where services were provided.
    • Institutions risk civil penalties for noncompliance.

  • Group health plans and health insurance issuers offering group coverage

    • Must verify that submitted claims for off-campus outpatient services include the required department health identifier.
    • Must deny or withhold payment for claims that do not meet the new requirements.

  • Enforcement bodies (Secretary of Labor)

    • Responsible for implementing the rule and imposing penalties for violations.

Notable procedural and timeline aspects

  • Rulemaking implementation: The bill directs the Secretary of Labor to implement the new requirements via rulemaking, indicating detailed regulatory development will follow enactment.
  • Effective date: The requirements apply to plan years starting on or after January 1, 2027, providing a lead time for compliance and regulatory development.

Practical impact and considerations

  • The bill seeks transparency in hospital billing by tying payment eligibility to the presence of a department-specific health identifier on claims for off-campus outpatient services.
  • Potential effects include:
    • Increased administrative burden on hospitals to obtain and attach department identifiers.
    • Enhanced oversight of billing accuracy and potential reduction in billing errors or inflated charges for off-campus services.
    • Financial penalties for non-compliance, with a split structure based on hospital size.
  • The scope focuses specifically on off-campus outpatient departments and claims submitted to group health plans and issuers offering group coverage.

If you’d like, I can provide a side-by-side comparison with current ERISA billing practices or a plain-language FAQ for stakeholders (hospitals, plans, and beneficiaries).

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

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