Transparency in Billing Act of 2026

Key Points

• Hospitals must obtain and use a separate unique health identifier for every off-campus outpatient department when billing group health plans. This ensures insurance companies and patients can see exactly where care was provided, preventing hospitals from disguising off-site clinics as part of the main hospital campus.
• Group health plans and insurers are banned from paying hospital claims for off-campus outpatient services unless the claim includes the correct unique identifier for the specific department where care was delivered. This stops hospitals from billing at higher hospital rates for services performed at smaller satellite offices.
• Hospitals that violate these billing rules face daily civil fines. Smaller hospitals (30 beds or fewer) can be fined up to $300 per day, while larger hospitals face penalties of up to $5,500 per day the violation continues.
• The Labor Department must create a process within one year for people to report suspected billing violations, giving patients and insurers a way to flag hospitals that are not following the rules.
• The new requirements take effect for plan years beginning on or after January 1, 2027, meaning most employer-sponsored health plans would start seeing these changes during 2027. The Secretary of Labor must implement the law through formal rulemaking.

Votes

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Related Bills

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