,i  #aai? ,,congress  #a/ ,session  ,h4 
,r4 #bfg  ,,9 ,,! ,,h\se ,,(            
,,repres5tatives  ,janu>y #i1 #bjbe,mr4 
,davidson introduc$ ! foll[+ bill2 :i* 0
 ref]r$ to ! ,committee on ,en]gy &     
,comm]ce  ,a ,,bill  ,to am5d ! ,public 
,heal? ,s]vice ,act to provide =        
hospital & insur] price transp>5cy4  #a4
 ,%ort title ,?is ,act may be cit$ z !  
,heal? ,c>e ,prices ,reveal$ &          
,in=mation to ,consum]s ,expla9$        
,transp>5cy ,act or ! ,heal? ,c>e       
,,price ,transp>5cy ,act4  #b4 ,price   
transp>5cy requirem5ts  7a7 ,hospitals  
,section #bgah7;e7 ( ! ,public ,heal?   
,s]vice ,act 7#db ,u4,s4,c4             
#cjj;gg-#ah7;e77 is am5d$-- 7#a7 by     
/rik+ ,ea* hospital & ins]t+ ! foll[+3  
7#a7 ,9 g5]al ,ea* hospital  2  7#b7 by 
ins]t+ 1 9 pla9 language )\t            
subscription & free ( *>ge1 9 a         
consum]-fri5dly1 ma*9e-readable =mat1   
aft] a li/2 &  7#c7 by add+ at ! end !  
foll[+3 8,ea* hospital %all include 9   
its li/ ( /&>d *>ges1 along ) su*       

additional in=mation z ! ,secret>y may  
require ) respect to su* *>ges =        
purposes ( promot+ public aw>5ess (     
hospital pric+ 9 advance ( receiv+ a    
hospital item or s]vice1 z applicable1 !
 foll[+3  7,a7 ,a description ( ea* item
 or s]vice provid$ by ! hospital4  7,b7 
,! gross *>ge4  7,c7 ,any pay]-specific 
negotiat$ *>ge cle>ly associat$ ) ! "n (
 ! ?ird p>ty pay] & plan4  7,d7 ,!      
de-id5tifi$ m9imum negotiat$ *>ge4  7,e7
 ,! de-id5tifi$ maximum negotiat$ *>ge4 
7,f7 ,! disc\nt$ ca% price4  7,g7 ,any  
code us$ by ! hospital = purposes (     
acc\nt+ or bill+1 includ+ ,curr5t       
,proc$ural ,t]m9ology 7,,cpt7 code1 !   
,heal?c>e ,common ,proc$ure ,cod+ ,sy/em
 7,,hcpcs7 code1 ! ,diagnosis ,relat$   
,gr\p 7,,drg71 ! ,national ,drug ,code  
7,,ndc71 or o!r common pay] id5tifi]4   
7#b7 ,deliv]y me?ods & use  7,a7 ,9     
g5]al ,ea* hospital %all make public !  
/&>d *>ges describ$ 9 p>agraph 7#a7 = z 
_m ( ! #gj ,c5t]s = ,m$icaid  ,m$ic>e   
,s]vices-specifi$ %oppable s]vices t are

 provid$ by ! hospital1 & z _m          
additional hospital-select$ %oppable    
s]vices z may be necess>y = a comb9$    
total ( at lea/ #cjj %oppable s]vices1  
includ+ ! rate at :i* a hospital        
provides & bills = t %oppable s]vice4   
,if a hospital does n provide #cjj      
%oppable s]vices 9 accordance ) !       
previ\s s5t5ce1 ! hospital %all make    
public ! in=mation specifi$ "u p>agraph 
7#a7 = z _m %oppable s]vices z x        
provides4  7,b7 ,det]m9ation by ,,cms ,a
 hospital %all be deem$ by ! ,c5t]s =   
,m$ic>e  ,m$icaid ,s]vices to meet !    
requirem5ts ( subp>agraph 7,a7 if !     
hospital ma9ta9s an int]net-bas$ price  
e/imator tool t meets ! foll[+          
requirem5ts3 7i7 ,! tool provides       
e/imates = z _m ( ! #gj specifi$        
%oppable s]vices t are provid$ by !     
hospital1 & z _m additional             
hospital-select$ %oppable s]vices z may 
be necess>y = a comb9$ total ( at lea/  
#cjj %oppable s]vices4  7ii7 ,! tool    
all[s heal? c>e consum]s to1 at ! "t !y 

use ! tool1 obta9 an e/imate ( ! am\nt  
!y w be obligat$ to pay ! hospital = !  
%oppable s]vice4  7iii7 ,! tool is      
prom95tly display$ on ! hospital's      
website & easily accessible to ! public1
 )\t subscription1 fee1 or hav+ to      
submit p]sonal id5tify+ in=mation       
7,,pii71 & se>*able by s]vice           
description1 bill+ code1 & pay]4  7#c7  
,def9itions ,not)/&+ any o!r provision (
 law1 = ! purpose ( p>agraphs 7#a7 &    
7#b73 7,a7 ,de-id5tifi$ maximum         
negotiat$ *>ge ,! t]m de-id5tifi$       
maximum negotiat$ *>ge means ! highe/   
*>ge t a hospital has negotiat$ ) all   
?ird p>ty pay]s = an item or s]vice4    
7,b7 ,de-id5tifi$ m9imum negotiat$ *>ge 
,! t]m de-id5tifi$ m9imum negotiat$ *>ge
 means ! l[e/ *>ge t a hospital has     
negotiat$ ) all ?ird p>ty pay]s = an    
item or s]vice4  7,c7 ,disc\nt$ ca%     
price ,! t]m disc\nt$ ca% price means ! 
*>ge t applies to an individual :o pays 
ca%1 or ca% equival5t1 = a hospital item
 or s]vice4 ,hospitals t d n (f]        

self-pay disc\nts may display !         
hospital's undisc\nt$ gross *>ges z f\nd
 9 ! hospital *>gema/]4  7,d7 ,gross    
*>ge ,! t]m gross *>ge means ! *>ge = an
 individual item or s]vice t is reflect$
 on a hospital's *>gema/]1 abs5t any    
disc\nts4  7,e7 ,pay]-specific negotiat$
 *>ge ,! t]m pay]-specific negotiat$    
*>ge means ! *>ge t a hospital has      
negotiat$ ) a ?ird p>ty pay] = an item  
or s]vice4  7,f7 ,%oppable s]vice ,! t]m
 %oppable s]vice means a s]vice t c be  
s*$ul$ by a heal? c>e consum] 9 advance4
  7,g7 ,/&>d *>ges ,! t]m /&>d *>ges    
means ! regul> rate e/abli%$ by !       
hospital = an item or s]vice1 includ+   
bo? individual items & s]vices & s]vice 
packages1 provid$ to a specific gr\p (  
pay+ pati5ts1 includ+ ! gross *>ge1 !   
pay]-specific negotiat$ *>ge1 ! disc\nt$
 ca% price1 ! de-id5tifi$ m9imum        
negotiat$ *>ge1 ! de-id5tifi$ maximum   
negotiat$ *>ge1 & o!r rates det]m9$ by !
 ,secret>y4  7,h7 ,?ird p>ty pay] ,! t]m
 ?ird p>ty pay] means an entity t is1 by

 /atute1 contract1 or agreem5t1 legally 
responsible = paym5t ( a claim = a heal?
 c>e item or s]vice4  7#d7 ,en=cem5t ,9 
addition to any o!r en=cem5t actions or 
p5alties t may apply "u subsection      
7b77#c7 or ano!r provision ( law1 a     
hospital t fails to provide ! in=mation 
requir$ by ?is subsection & has n       
complet$ a corrective action plan to    
comply ) ! requirem5ts ( su* subsection 
%all be subject to a civil monet>y      
p5alty ( an am\nt n to exce$ #cjj p] day
 t ! violation is ongo+ z det]m9$ by !  
,secret>y4 ,su* p5alty %all be impos$ & 
collect$ 9 ! same mann] z civil money   
p5alties "u subsection 7a7 ( section    
#aabh;,a ( ! ,social ,security ,act are 
impos$ & collect$4  4  7b7 ,transp>5cy 9
 cov]age ,section #acaa7;e77#c7 ( !     
,pati5t ,protection & ,af=dable ,c>e    
,act 7#db ,u4,s4,c4 #ahjca7;e77#c77 is  
am5d$-- 7#a7 9 subp>agraph 7,a7-- 7,a7  
by r$esignat+ clause 7ix7 z clause      
7xii72 &  7,b7 by ins]t+ aft] clause    
7viii71 ! foll[+3  7ix7 ,9-network      

provid] rates = cov]$ items & s]vices4  
7x7 ,out-(-network all[$ am\nts & bill$ 
*>ges = cov]$ items & s]vices4  7xi7    
,negotiat$ rates & hi/orical net prices 
= cov]$ prescription drugs4  2  7#b7 9  
subp>agraph 7,b7-- 7,a7 9 ! head+1 by   
/rik+ use & ins]t+ deliv]y me?ods & use2
  7,b7 by ins]t+ & subp>agraph 7,c7 aft]
 subp>agraph 7,a72  7,c7 by ins]t+ 1 z  
applicable1 aft] ,engli% pr(ici5cy2 &   
7,d7 by ins]t+ aft] ! second s5t5ce1 !  
foll[+3 8,! ,secret>y %all e/abli% /&>ds
 = ! me?ods & =mats = disclos+ in=mation
 to individuals4 ,at a m9imum1 ^! /&>ds 
%all include ! foll[+3  7i7 ,an         
int]net-bas$ self-s]vice tool to provide
 in=mation to an individual 9 pla9      
language1 )\t subscription & free (     
*>ge1 9 a ma*9e readable =mat1 ?r\gh a  
self-s]vice tool on an int]net website t
 provides real-"t responses bas$ on     
co/-%>+ in=mation t is accurate at ! "t 
( ! reque/ t all[s1 at a m9imum1 us]s   
to-- 7,i7 se>* = co/-%>+ in=mation = a  
cov]$ item or s]vice provid$ by a       

specific 9-network provid] or by all    
9-network provid]s2  7,,ii7 se>* = an   
out-(-network all[$ am\nt1 p]c5tage (   
bill$ *>ges1 or o!r rate t provides a   
reasonably accurate e/imate ( ! am\nt an
 insur] w pay = a cov]$ item or s]vice  
provid$ by out-(-network provid]s2 &    
7,,iii7 ref9e & reord] se>* results bas$
 on geographic proximity ( 9-network    
provid]s1 & ! am\nt ( ! individual's    
co/-%>+ liability = ! cov]$ item or     
s]vice1 to ! ext5t ! se>* = co/-%>+     
in=mation = cov]$ items or s]vices      
returns multiple results4  7ii7 ,9 pap] 
=m at ! reque/ ( ! individual t includes
 no few] ?an #bj provid]s p] reque/ )   
respect to :i* co/-%>+ in=mation = cov]$
 items & s]vices is provid$1 & discloses
 ! applicable provid] p]-reque/ limit to
 ! individual1 mail$ to ! individual n  
lat] ?an #b bus9ess days aft] receiv+ an
 individual's reque/4  2  7#c7 9        
subp>agraph 7,c7-- 7,a7 9 ! fir/        
s5t5ce-- 7i7 by /rik+ ,! ,ex*ange &     
ins]t+ ! foll[+3  7i7 ,9 g5]al ,!       

,ex*ange  2  7ii7 by ins]t+ or          
out-(-network provid] aft] item or      
s]vice by a p>ticipat+ provid]2 &  7iii7
 by ins]t+ be=e ! p]iod ! foll[+3 8!    
foll[+ in=mation3  7i7 ,an e/imate ( an 
individual's co/-%>+ liability = a      
reque/$ cov]$ item or s]vice furni%$ by 
a provid]1 :i* %all reflect any co/-%>+ 
r$uctions ! individual w\ld receive4    
7ii7 ,a description ( ! accumulat$      
am\nts4  7iii7 ,! 9-network rate1       
includ+ negotiat$ rates & und]ly+ fee   
s*$ule rates4  7iv7 ,! out-(-network    
all[$ am\nt or any o!r rate t provides a
 m accurate e/imate ( an am\nt an issu] 
w pay1 includ+ ! p]c5t reimburs$ by     
insur]s to out-(-network provid]s1 = !  
reque/$ cov]$ item or s]vice furni%$ by 
an out-(-network provid]4  7v7 ,a li/ ( 
! items & s]vices includ$ 9 bundl$      
paym5t arrangem5ts = :i* co/-%>+        
in=mation is be+ disclos$4  7vi7 ,a     
notification t cov]age ( a specific item
 or s]vice is subject to a pr]equisite1 
if applicable4  7vii7 ,a notice t       

includes ! foll[+ in=mation3 7,i7 ,a    
/atem5t t out-(-network provid]s may    
bill individuals = ! diff]5ce1 includ+ !
 balance bill+1 betwe5 a provid]'s bill$
 *>ges & ! sum ( ! am\nt collect$ f !   
insur] 9 ! =m ( a copaym5t or co9surance
 am\nt & ! co/-%>+ in=mation4  7,,ii7 ,a
 /atem5t t ! actual *>ges = an          
individual's cov]$ item or s]vice may be
 diff]5t f an e/imate ( co/-%>+         
liability dep5d+ on ! actual items or   
s]vices ! individual receives at ! po9t 
( c>e4  7,,iii7 ,a /atem5t t ! e/imate (
 co/-%>+ liability = a cov]$ item or    
s]vice is n a gu>antee t b5efits w be   
provid$ = t item or s]vice4  7,,iv7 ,a  
/atem5t disclos+ :e!r ! plan c\nts      
copaym5t assi/ance & o!r ?ird-p>ty      
paym5ts 9 ! calculation ( ! individual's
 d$uctible & out-(-pocket maximum4  7,v7
 ,= items & s]vices t are recomm5d$     
prev5tive s]vices "u section #bgac ( !  
,public ,heal? ,s]vice ,act1 a /atem5t t
 an 9-network item or s]vice may n be   
subject to co/-%>+ if x is bill$ z a    

prev5tive s]vice 9 ! insur] _c det]m9e  
:e!r ! reque/ is = a prev5tive or       
non-prev5tive item or s]vice4  7,,vi7   
,any additional in=mation1 includ+ o!r  
disclaim]s1 t ! insur] det]m9es is      
appropriate1 provid$ ! additional       
in=mation does n conflict ) ! in=mation 
requir$ to be provid$ by ?is subsection4
  2  7,b7 by /rik+ ! second s5t5ce2 &   
7,c7 by add+ at ! end ! foll[+3  7ii7   
,def9itions ,not)/&+ any o!r provision (
 law1 = ! purpose ( ?is subp>agraph &   
subp>agraphs 7,a7 & 7,b73 7,i7          
,accumulat$ am\nts ,! t]m accumulat$    
am\nts means ! am\nt ( f9ancial         
responsibility an individual has incurr$
 at ! "t a reque/ = co/-%>+ in=mation is
 made1 ) respect to a d$uctible or      
out-(-pocket limit1 includ+ any exp5se t
 c\nts t[>d a d$uctible or out-(-pocket 
limit1 b exclude any exp5se t does n    
c\nt t[>d a d$uctible or out-(-pocket   
limit4 ,to ! ext5t an insur] imposes a  
cumulative treatm5t limitation on a     
p>ticul> cov]$ item or s]vice indep5d5t 

( individual m$ical necessity           
det]m9ations1 ! am\nt t has accru$ t[>d 
! limit on ! item or s]vice4  7,,ii7    
,hi/orical net price ,! t]m hi/orical   
net price means ! retrospective av]age  
am\nt an insur] paid = a prescription   
drug1 inclusive ( any reasonably        
allocat$ rebates1 disc\nts1 *>gebacks1  
fees1 & any additional price concessions
 receiv$ by ! insur] ) respect to !     
prescription drug4 ,! allocation %all be
 det]m9$ by doll> value = non-product   
specific & product-specific rebates1    
disc\nts1 *>gebacks1 fees1 & o!r price  
concessions to ! ext5t t ! total am\nt (
 any su* price concession is kn[n to !  
insur] at ! "t ( publication ( !        
hi/orical net price4  7,,iii7 ,negotiat$
 rate ,! t]m negotiat$ rate means !     
am\nt a plan or issu] has contractually 
agre$ to pay = a cov]$ item or s]vice1  
:e!r directly or indirectly ?r\gh a ?ird
 p>ty adm9i/rator or ph>macy b5efit     
manag]1 to an 9-network provid]1 includ+
 an 9-network ph>macy or o!r            

prescription drug disp5s]1 = cov]$ items
 or s]vices4  7,,iv7 ,out-(-network     
all[$ am\nt ,! t]m out-(-network all[$  
am\nt means ! maximum am\nt an insur] w 
pay = a cov]$ item or s]vice furni%$ by 
an out-(-network provid]4  7,v7         
,out-(-network limit ,! t]m             
out-(-network limit means ! maximum     
am\nt t an individual is requir$ to pay 
dur+ a cov]age p]iod = 8 or h] %>e ( !  
co/s ( cov]$ items & s]vices "u 8 or h] 
plan or cov]age1 includ+ = self-only &  
o!r ?an self-only cov]age1 z applicable4
  7,,vi7 ,und]ly+ fee s*$ule rates ,!   
t]m und]ly+ fee s*$ule rates means !    
rate = an item or s]vice t a plan or    
issu] uses to det]m9e a p>ticipant's1   
b5efici>y's1 or enrollee's co/-%>+      
liability f a p>ticul> provid] or       
provid]s1 :5 ! rate is diff]5t f !      
negotiat$ rate4  2  7#d7 9 subp>agraph  
7,d71 by /rik+ subp>agraph 7,a7 & ins]t+
 subp>agraphs 7,a71 7,b71 & 7,c72 &     
7#e7 by add+ at ! end ! foll[+3  7,f7   
,application ( p>agraph ,9 addition to  

qualifi$ heal? plans 7& plans seek+     
c]tification z qualifi$ heal? plans71   
?is p>agraph 7z am5d$ by ! ,heal? ,c>e  
,prices ,reveal$ & ,in=mation to        
,consum]s ,expla9$ ,transp>5cy ,act7    
%all apply to gr\p heal? plans 7includ+ 
self-insur$ & fully insur$ plans7 &     
heal? insurance cov]age 7z su* t]ms are 
def9$ 9 section #bgia ( ! ,public ,heal?
 ,s]vice ,act74  4