Transparency in Billing Act of 2026

Regulatory or Legal Changes Top 1

Hospital Off-Campus Billing Identifier Mandate

Prohibits hospitals from submitting claims to group health plans or health insurance issuers for items and services furnished at off-campus outpatient departments—and from holding patients liable for such services—unless the hospital has obtained a separate unique health identifier for that department and includes it on the claim. Authorizes the Secretary of Labor to assess civil monetary penalties against hospitals that violate the off-campus outpatient billing identifier requirement, scaled by hospital size—up to $300 per day for hospitals with 30 or fewer beds and up to $5,500 per day for larger hospitals—and directs the Secretary to establish a process for reporting suspected violations within one year of enactment.

• Population Scope Medium Directly binds hospitals with off-campus outpatient departments and the group health plans and issuers covering roughly 160 million employer-sponsored enrollees, placing it in the 10–25% range of the U.S. population.
• Budgetary Magnitude Low No funds are authorized or appropriated; civil penalties flow to the government rather than constituting an expenditure, and compliance costs fall on private hospitals rather than the federal budget.
• Legal / Regulatory Depth High Creates a new statutory prohibition under ERISA with binding legal effect across all hospitals billing group health plans — a new enforceable duty that did not previously exist in the statute.
• Degree of Discretion Granted Medium The Department of Labor (DOL) must implement through rulemaking and establish a violation-reporting process, but the core prohibition is mandatory ('may not'), leaving the Secretary of Labor discretion mainly in penalty assessment and rulemaking design rather than whether to act.
• Implementation & Enforcement Burden High Imposes an affirmative compliance obligation on every covered hospital, requires DOL to stand up a new violation-reporting infrastructure within one year, and establishes a recurring per-day civil penalty adjudication regime scaled by hospital size.
• Temporal Commitment High Persists indefinitely until Congress acts to repeal or amend it, with no sunset, expiry, or mandatory reauthorization.