S. 2355: Patients Deserve Price Tags Act

The "Patients Deserve Price Tags Act" aims to enhance transparency in the healthcare pricing system. It requires hospitals and insurers to publicly disclose the costs of medical services in a format that is easy for consumers to understand. This requirement for price transparency will begin on January 1, 2026.

Requirements for Hospitals

Starting from 2026, hospitals will be mandated to:

• Publicly disclose their standard charges for various services.
• Ensure that the pricing information is presented in a consumer-friendly manner.
• Facilitate easy access to pricing information for clinical diagnostic laboratories and ambulatory surgical centers.

Health Plans Transparency

Health plans will also need to comply with transparency measures by providing detailed information regarding:

• In-network rates for services.
• Cost-sharing amounts for patients.
• Accumulated deductibles for services rendered.

This information must be available via a self-service tool and will be submitted monthly, starting from January 1, 2027. Non-compliance with these requirements will result in civil penalties.

Claims Submission and Billing Transparency

The bill outlines requirements for how claims and adjustments for health services must be submitted. The specifics include:

• Claims must be submitted in designated electronic formats.
• Self-funded governmental plans will not incur related costs for these submissions.
• Healthcare providers must provide itemized bills that detail the services rendered, including associated costs and coding.

Similar to the previous sections, non-compliance with these regulations will also incur penalties, which will be determined and outlined by the Secretary through rulemaking.

Enforcement and Compliance

The bill establishes a framework for enforcement, where penalties will be enacted for any entities that do not comply with the mandated transparency requirements. This is aimed at ensuring adherence and promoting accountability among hospitals and health insurers.

Timeline for Implementation

• January 1, 2026: Hospitals must begin disclosing standard charges.
• January 1, 2026: Effective date for the overall compliance measures for hospitals.
• January 1, 2027: Health plans must provide comprehensive rate and payment information publicly.

Relevant Companies

• HCA Healthcare (HCA): As a major hospital operator, HCA will need to adapt its pricing disclosure practices to comply with the bill's transparency requirements.
• Universal Health Services (UHS): Another significant player in the healthcare sector, Universal Health Services will face similar obligations regarding price transparency.
• Anthem, Inc. (ANTM): As a health insurance provider, Anthem will need to ensure that it provides the required rate and payment information to consumers effectively.