H.R. 5582: Patients Deserve Price Tags Act

The "Patients Deserve Price Tags Act" aims to enhance transparency in healthcare pricing by requiring hospitals and health insurers to disclose clear pricing information for medical services. This includes both standard charges and discounted rates, which must be presented in formats that are easily accessible to the public. The act emphasizes compliance and establishes a timeline, with full compliance expected by July 1, 2027, and outlines penalties for non-compliance.

Requirements for Hospitals and Insurers

• Hospitals must provide transparent pricing information regarding medical services.
• Health plans must disclose key pricing details, including:
  • In-network rates
  • Cost-sharing amounts
  • Prior authorization requirements
• Information must be made available online in a standardized format for real-time access.

Compliance, Reporting, and Penalties

• The bill requires ongoing compliance monitoring of both hospitals and health insurers.
• Regular reporting and audits will be mandated to ensure adherence to the requirements.
• Significant penalties will be imposed for entities that fail to comply with the regulations.

Claims and Payment Standards

• The act mandates specific formats for submitting claims and payments.
• Claims must be submitted in unmodified electronic format at no cost to self-funded governmental health plans.
• Contractual terms that obstruct access to pricing information are prohibited.
• Penalties for non-compliance with these submission standards are also established.
• The Secretary of the relevant department is authorized to modify standards as necessary to improve clarity and accessibility of information.

Relevant Companies

• None found