Technical corrections only. The diff updates cross-references and renumbers a new paragraph in Section 4 from (13) to (14), also adding a descriptive heading. No substantive policy changes were made between v1 and v2.
Transparency in Billing Act of 2026
- Sponsor
- Rep. Foxx, Virginia [R-NC-5]
- Committees
- Education and Workforce Committee (primary)
- Last action
- Jul 13, 2026
Bottom line
This bill aims to increase transparency in hospital billing for off-campus outpatient services by requiring unique identifiers on claims, with penalties for non-compliance, to protect consumers and insurers from opaque billing practices.
What it actually does
This bill amends the Employee Retirement Income Security Act of 1974 (ERISA) to prohibit group health plans and health insurance issuers from paying claims for services furnished at 'off-campus outpatient departments of a provider' unless the claim includes a separate unique health identifier for that specific department. It also directly prohibits hospitals from submitting such claims or holding individuals liable for services without this identifier. The bill mandates the Secretary of Labor to establish a process for reporting violations and empowers the Secretary to assess civil monetary penalties against non-compliant hospitals.
Proponents argue
Proponents argue that this bill directly addresses the problem of opaque and often higher billing for services rendered at off-campus hospital facilities, ensuring consumers and insurers know exactly where services were provided. They contend it promotes transparency, reduces billing errors, and protects individuals from unexpected costs, ultimately contributing to more predictable healthcare expenditures and fairer pricing.
Opponents contend
Opponents might argue that this legislation imposes significant new administrative burdens and compliance costs on hospitals, particularly those with numerous off-campus sites, which could ultimately be passed on to patients through higher charges or premiums. They may also contend that existing regulations are sufficient or that this specific requirement does not address the fundamental drivers of healthcare costs.
The bill is short and relatively focused, making it accessible for an informed reader to understand its core provisions quickly.
Section 2(a), adding new section 727 to ERISA
Prohibition on Payment of Claims Without Unique Identifier
This provision prohibits group health plans and health insurance issuers from paying claims for items and services furnished to an individual at an 'off-campus outpatient department of a provider' unless the claim includes a separate unique health identifier for that specific department. This means insurers cannot process payments if the hospital does not properly identify the location of service.
Supporters argue
Supporters argue this provision ensures that claims are accurately attributed to the specific facility where services were rendered, preventing plans and issuers from paying for potentially miscoded or inflated charges from off-campus sites. This promotes transparency and accountability in billing.
Critics contend
Critics might argue this adds an administrative burden on plans and issuers to verify these identifiers, potentially slowing down claim processing and increasing operational costs, which could be passed on to consumers through higher premiums.
Tradeoffs
Balances the desire for billing transparency and accuracy against potential administrative overhead for health plans and insurers.
Section 3(a), adding new part 9, section 901 to ERISA
Hospital Obligation for Unique Identifiers and Patient Protection
This provision directly prohibits hospitals from submitting claims for services at off-campus outpatient departments to group health plans or issuers, or from holding individuals liable for such services, unless the hospital has obtained and included a separate unique health identifier for that department on the claim. This places the primary responsibility for accurate identification on the hospitals.
Section 4, amending Section 502 of ERISA
Secretarial Enforcement Authority and Penalties for Violations
This section grants the Secretary of Labor the authority to assess civil monetary penalties against hospitals that violate the new honest billing requirements. The penalties are tiered based on hospital bed count: up to $300 per day for hospitals with 30 or fewer beds, and up to $5,500 per day for hospitals with more than 30 beds, for each day the violation is ongoing.
Section 5
Implementation through Rulemaking
This section directs the Secretary of Labor to implement the amendments made by this Act through rulemaking. This means the specific details and procedures for compliance and enforcement will be developed and formalized through the administrative process, allowing for public comment and expert input.
Defines 'off-campus outpatient department of a provider' by referencing section 413.65 of title 42, Code of Federal Regulations, or any successor regulation, and specifies that it's a department not located on the provider's campus or within the defined distance from a remote location of a hospital facility.
Section 3(c), adding new section 901(c) to ERISA
Why it matters:Standard legislative practice to reference existing regulatory definitions to avoid redundancy and maintain consistency with current healthcare terminology and established federal frameworks.
Case for: Supporters argue that referencing existing definitions ensures consistency with current healthcare regulations and avoids creating new, potentially conflicting, definitions. It leverages established terminology and avoids unnecessary legislative text.
Case against: Critics might argue that relying on external, potentially changing, regulations makes the bill's scope less transparent and harder for the average reader to immediately grasp without additional research, potentially obscuring its full impact.
Estimated impact: This definition is central to the bill's applicability, determining which hospital facilities and claims are subject to the new requirements. Its scope directly impacts a significant portion of outpatient services.
Requires hospitals to obtain a separate unique health identifier established for such department pursuant to section 1173(b) of the Social Security Act.
Section 3(a), adding new section 901(a)(1) to ERISA
Why it matters:Standard legislative practice to integrate with existing federal frameworks for health information technology and identifiers, ensuring consistency and avoiding duplication of effort in establishing new systems.
Case for: Supporters argue that linking to existing Social Security Act provisions for unique health identifiers ensures that the bill leverages established infrastructure and standards, promoting interoperability and reducing the need for new, separate systems.
Case against: Critics might suggest that such cross-references make the bill less self-contained and more difficult for stakeholders to fully understand without deep knowledge of multiple federal statutes, potentially leading to confusion during implementation.
Estimated impact: This reference dictates the standard and process by which hospitals must obtain the required identifiers, impacting their administrative and IT systems for compliance.