Patients Deserve Price Tags Act: Proposed Transparency Law Has Fines up to $10,000,000

The Patients Deserve Price Tags Act is a proposed federal law that would dramatically expand and standardize medical price transparency rules for hospitals, labs, imaging centers, ambulatory surgery centers (ASCs), and health plans.

If passed, it would set strict deadlines for posting clear prices, require easier-to-read medical bills, and give patients better tools to understand costs before they get care. It would also increase penalties for organizations that do not follow the rules, with fines far higher than current Hospital Price Transparency enforcement.

High-Level Overview of the Patients Deserve Price Tags Act

Broader scope: The Patients Deserve Price Tags Act would extend federal price transparency rules beyond hospitals to include clinical laboratories, imaging centers, ambulatory surgical centers, and health plans.

Stricter requirements: Providers must post detailed, machine-readable price lists more frequently, include all negotiated rates, and accept posted cash prices as payment in full if a patient chooses that option.

Patient-friendly billing: The Patients Deserve Price Tags Act requires itemized medical bills and clearer explanations of benefits (EOBs) within specific timelines.

Health plan transparency: Insurers must enhance online price estimator tools, publish monthly rate and drug cost files, and protect patients from underestimation errors for Patients Deserve Price Tags Act compliance.

Data access rights: Self-funded employers must receive complete claims and pricing data from third-party administrators and pharmacy benefit managers without restrictions; penalties apply to service providers that block access.

Higher penalties: Proposed Patients Deserve Price Tags Act fines scale by organization size and increase for persistent noncompliance; additional penalties apply to plans and service providers.

Tight timelines: If the Patients Deserve Price Tags Act passes, most hospital and plan changes will take effect January 1, 2026; labs, imaging centers, and ASCs follow on July 1, 2027.

Why the Patients Deserve Price Tags Act Matters

The Patients Deserve Price Tags Act focuses on price transparency for healthcare services. This means patients can see before treatment how much a medical service will cost, both the list price and the expected amount after insurance, so they can make informed choices.

The federal government already enforces Hospital Price Transparency rules for hospitals and Transparency in Coverage rules for health plans. These require posting price lists online and offering cost-estimator tools. Compliance has been uneven, and penalties have been relatively small.

The Patients Deserve Price Tags Act builds on these rules with tougher enforcement, clearer formats, and new requirements for more types of providers.

Who Will the Patients Deserve Price Tags Act Impact?

The Patients Deserve Price Tags Act applies across nearly every segment of the care delivery and payment system. While the core requirements are consistent, the timelines, formats, and enforcement mechanisms vary by entity type.

Hospitals are the first group expected to comply under the new Patients Deserve Price Tags Act framework. If the law passes, clinical laboratories, imaging providers, and ambulatory surgery centers will follow. Health plans, insurers, and plan administrators also face sweeping changes that will require new technology, contract updates, and more rigorous oversight.

Hospitals — effective January 1, 2026

The proposed Patients Deserve Price Tags Act includes the following requirements for hospitals:

• Post all prices every month in a standard, downloadable format.
• Include plain-language descriptions, billing codes, list prices (gross charges), discounted cash prices, insurer-specific negotiated rates, and the highest and lowest rates paid.
• Must accept the posted cash price as payment in full if the patient chooses to pay cash.
• Publish a consumer-friendly list of shoppable services. This expands from 300 services to all shoppable services after 2026.
• CEOs and CFOs must sign off each year confirming the accuracy of posted prices.

Clinical laboratories — effective July 1, 2027

The proposed Patients Deserve Price Tags Act includes the following requirements for clinical laboratories:

• Post monthly price lists for lab tests, including all ancillary services.
• Same format and data requirements as hospitals.
• Must accept the posted cash price if a patient chooses to pay cash.

Imaging providers — effective July 1, 2027

The proposed Patients Deserve Price Tags Act includes the following requirements for imaging providers:

• Applies to non-hospital imaging centers such as MRI, CT, and ultrasound providers.
• Must post price lists in a standard, downloadable format, update at least annually, and accept the posted cash price.

Ambulatory surgery centers (ASCs) — effective July 1, 2027

The proposed Patients Deserve Price Tags Act includes the following requirements for ASCs:

• Applies to specified ASCs in which a hospital or a hospital owner has an ownership or control interest.
• Post annual price lists plus a consumer-friendly list of 300 shoppable services.
• Same data requirements as hospitals and must accept the posted cash price.

Health plans and insurers

The proposed Patients Deserve Price Tags Act includes the following requirements for health plans and insurers:

• From January 1, 2026:
  • Update online price estimator tools to give accurate, near real-time cost information and hold members harmless if the tool underestimates cost.
• From January 1, 2027:
  • Publish monthly, downloadable files showing in-network prices, out-of-network allowed amounts, and drug pricing including historical net prices paid after rebates.

Plan sponsors and third-party administrators

The proposed Patients Deserve Price Tags Act includes the following requirements for plan sponsors and 3rd-party admins:

• Employers with self-funded health plans must have full access to claims and pricing data from their administrators such as TPAs and PBMs.
• Bans gag clauses in contracts that hide pricing details.
• Violations could mean penalties of $100,000 per day.

Patient billing and EOBs

The proposed Patients Deserve Price Tags Act includes the following requirements for patient billing and EoBs:

• Explanations of Benefits (EOBs): Starting January 1, 2026, must be sent within 45 days of a claim, showing what was billed, what the plan paid, and the patient’s cost.
• Itemized medical bills: Providers must send a detailed bill before sending a patient to collections and cannot charge more than the posted price or a Good Faith Estimate unless medically necessary, unforeseen items, or a patient-initiated change is documented.

Risks of Noncompliance for Healthcare Organizations Today

Failure to comply with existing Hospital Price Transparency and Transparency in Coverage rules already carries significant consequences. CMS has been actively enforcing the hospital rule since 2021, issuing warning letters, corrective action plans, and civil monetary penalties.

In 2022, CMS increased the maximum penalty for large hospitals to $5,500 per day, raising potential annual fines from about $110,000 to over $2 million (45 CFR §180.90) (https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-E/part-180/section-180.90). Since enforcement began, CMS has posted 27 hospital CMPs as of June 26, 2025, with penalties ranging from $56,940 to $979,000.

Compliance remains inconsistent. An OIG audit estimated 46% of hospitals were not compliant with one or both core transparency requirements. Patient Rights Advocate reported 21.1% full compliance in November 2024. CMS has nevertheless continued posting CMPs and escalating oversight.

Federal enforcement around pricing and billing is already active, and penalties can be substantial. The following regulations set the current framework, and the Patients Deserve Price Tags Act would support this core initiative.

Hospital Price Transparency

This requirement originates from Section 2718(e) of the Public Health Service Act, added by Section 10101 of the Affordable Care Act, and is implemented at 45 CFR Part 180. CMS uses desk reviews and targeted audits to monitor compliance; penalties scale by hospital size and can exceed $2 million annually. 

Transparency in Coverage (TiC)

Created under the ACA and implemented through the Transparency in Coverage Final Rule, plans and issuers must post machine-readable files and provide a cost-comparison tool. Noncompliance can lead to $100 per affected individual per day under IRC §4980D and related agency guidance.

No Surprises Act (NSA)

42 U.S.C. §300gg-22 in the No Surprises Act (NSA) protects patients from certain surprise medical bills and balance billing. Providers and facilities that knowingly violate balance billing protections can face up to $10,000 per violation.

Proposed Non-Compliance Penalties Under the Patients Deserve Price Tags Act

The Patients Deserve Price Tags Act would sharply increase the cost of failing to meet transparency requirements compared to current Hospital Price Transparency penalties.

Hospitals

Proposed penalties for the Patients Deserve Price Tags Act are based on hospital size and increase after one year of non-compliance:

Hospital Size (Beds)	Fine per Bed per Day	Fine after 1 Year
30 beds or fewer	Up to $300/day	—
31–100 beds	$12.50/bed/day	$15/bed/day
101–300 beds	$17.50/bed/day	$20/bed/day
301–500 beds	$20/bed/day	$25/bed/day
More than 500 beds	$25/bed/day	$35/bed/day

Persistent non-compliance, defined as two or more violations in a year, could also trigger large lump-sum fines under the Patients Deserve Price Tags Act:

• 31–100 beds: $500,000–$1 million
• 101–300 beds: $1 million–$2 million
• 301–500 beds: $2 million–$4 million
• More than 500 beds: $5 million–$10 million

Labs, Imaging Centers, and Ambulatory Surgical Centers

For clinical laboratories, imaging centers, and specified ambulatory surgical centers in which a hospital or hospital owner has an ownership or control interest, the proposed Patients Deserve Price Tags Act penalty is up to $300 per day of noncompliance, with authority for HHS to raise the cap for 2027 and beyond by rule. 

These providers must post standard, downloadable price lists on the required schedule (monthly for labs, at least annually for imaging). They must also accept the posted discounted or minimum cash price if a patient chooses to pay cash. Penalties accrue after notice of violation.

Health Plans

For health plans, the Patients Deserve Price Tags Act allows penalties of up to $300 per member per day, capped at $10 million. These fines apply to failures to submit and publicly post the required three monthly machine-readable files, to maintain compliant online price estimator tools, or to honor the “hold harmless” requirement when the estimator underquotes a cost. The bill also directs regulators to conduct audits and require annual executive attestations of compliance.

Third-Party Administrators and PBMs

For third-party administrators (TPAs) and pharmacy benefit managers (PBMs) acting as health plan service providers, Patients Deserve Price Tags Act penalties can reach $100,000 per day for blocking or delaying required data access to plan fiduciaries. The proposal also bans contract “gag” clauses that restrict data sharing and mandates the delivery of claims and remittance data in standard formats to plan sponsors.

Bottom Line for Price Transparency Compliance

The Patients Deserve Price Tags Act marks a shift from broad transparency goals to detailed, enforceable requirements. Hospitals, labs, imaging centers, ASCs, and health plans will face more frequent reporting, stricter standards, and steeper penalties.

Meeting these requirements demands precise data management, consistent processes, and strong audit readiness. For many organizations, the biggest challenge is finding the bandwidth to manage these expanding mandates without pulling focus from patient services.

ChartRequest can give you that bandwidth. By automating HIPAA-compliant records release, we cut administrative work and free your team to focus on implementing price transparency strategies, meeting deadlines, and avoiding costly penalties. 

Schedule a personalized consultation to see how much time you can reclaim.