{"format":1,"id":"118-hr-5378","congress":118,"number":"H.R. 5378","kind":"bill","group":"bills","title":"Lower Costs, More Transparency Act","title_source":"Short Title(s) as Passed House","official_title":"To promote price transparency in the health care sector, and for other purposes.","titles":[{"type":"Official Title as Introduced","title":"To promote price transparency in the health care sector, and for other purposes."},{"type":"Display Title","title":"Lower Costs, More Transparency Act"},{"type":"Short Title(s) as Introduced","title":"Lower Costs, More Transparency Act"},{"type":"Short Title(s) as Passed House","title":"Lower Costs, More Transparency Act"}],"outcome":"passed_house","law_number":null,"introduced":"2023-09-08","chambers":{"house":{"status":"roll_call","date":"2023-12-11","vote":{"id":"118-2023-h708","question":"On Motion to Suspend the Rules and Pass, as Amended","title":"Lower Costs, More Transparency Act","result":"Passed","yea":320,"nay":71,"present":1,"not_voting":41,"source":"https://clerk.house.gov/evs/2023/roll708.xml"}},"senate":{"status":"na","date":null,"vote":null}},"president":{"status":"na","date":null},"vice_president_tie_breaker":null,"latest_action":{"text":"Motion to reconsider laid on the table Agreed to without objection.","date":"2023-12-11"},"nominees":null,"amendments":[],"other_votes":[],"crs_summary":{"date":"2023-12-11","stage":"Passed House","blocks":[{"k":"h","t":"Lower Costs, More Transparency Act"},{"k":"p","t":"This bill requires health care providers and insurers to disclose certain information about health care costs. It also establishes requirements for certain payment methodologies under Medicare and Medicaid and extends several public health programs."},{"k":"p","t":"For example, the bill provides statutory authority for regulations that require hospitals to annually publish their prices and related information, including the discounted cash price and negotiated charges. The bill also specifically extends these requirements to clinical laboratories, imaging service providers, and ambulatory surgical centers that participate in Medicare. Additionally, pharmacy benefit managers (PBMs) must semiannually report to health plan sponsors certain information on spending, rebates, and fees that are associated with covered drugs. Contracts with PBMs for employer-sponsored health plans must also allow health plan fiduciaries to audit certain claims and cost information without undue restrictions."},{"k":"p","t":"In addition, the bill requires pass-through pricing models, and prohibits spread-pricing, for payment arrangements with PBMs under Medicaid. It also requires Medicare payments for certain drug administration services at off-campus hospital outpatient departments to be the same as that for other provider settings (i.e., physician offices)."},{"k":"p","t":"The bill provides funds for the Department of Health and Human Services, the Department of Treasury, and the Department of Labor to implement and enforce the bill's requirements."},{"k":"p","t":"Finally, the bill extends several public health programs, including the Teaching Health Center Graduate Medical Education Program (through FY2030) and the National Health Service Corps (through December 31, 2025)."}],"words":239},"summary":{"main_subject":{"text":"Requires hospitals, other providers, health plans, insurers and pharmacy benefit managers to publish or disclose price and payment information, changes Medicare and Medicaid payment rules, sets contract terms for plan fiduciary data access, and extends funding for certain public health programs.","cites":[{"label":"Sec. 101","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H2B9674BFCA4C40398B3FEC043F9863F0"},{"label":"Sec. 105","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-HF3DE548260DC44FF9365A74690498CC3"},{"label":"Sec. 106","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-HD06AC933DA3544F082686017C051A6D9"},{"label":"Sec. 202","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-HCC954800F0A94AF6BD497AD3DF767E59"},{"label":"Sec. 301","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H444947BB5CB94B07A0AB3603BB92F52F"},{"label":"Sec. 401","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H4480F342AB8E47FDB5A8545369EF7EE5"}]},"core_areas":["Hospital, laboratory, imaging and ambulatory surgical center price publication","Health plan and insurer cost-sharing and in-network rate disclosure","Pharmacy benefit manager reporting to group health plans","Medicaid pharmacy payment and spread pricing","Medicare payment for off-campus hospital outpatient department services","Group health plan fiduciary access to claims data and service provider fee disclosure","Funding extensions for community health centers, the National Health Service Corps, teaching health centers and special diabetes programs"],"what_it_does":[{"text":"Requires hospitals, critical access hospitals and rural emergency hospitals paid by Medicare, beginning January 1, 2026, to publish their standard charges and prices for at least 300 shoppable services, and sets civil monetary penalties for noncompliance.","cite":{"label":"Sec. 101","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H2B9674BFCA4C40398B3FEC043F9863F0"}},{"text":"Requires laboratories paid by Medicare for specified clinical diagnostic laboratory tests, beginning January 1, 2026, to post online each test's discounted cash price and de-identified minimum and maximum negotiated charges, updated at least annually.","cite":{"label":"Sec. 102","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-HCDF7E4390B86408FA428CD48A1187ACA"}},{"text":"Requires providers and suppliers paid by Medicare for specified imaging services, beginning January 1, 2028, to post online the discounted cash price (or gross charge) for each service, updated at least annually.","cite":{"label":"Sec. 103","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H4156C477ACC84689B48FB0DFD3F87FCF"}},{"text":"Requires ambulatory surgical centers paid by Medicare, beginning January 1, 2026, to publish their standard charges and prices for at least 300 shoppable services in a machine-readable format.","cite":{"label":"Sec. 104","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H44612F46DB58436EB001A8FA31F45FC9"}},{"text":"Requires group health plans and insurers, for plan years beginning on or after January 1, 2026, to let enrollees learn their cost-sharing for a specific item or service and to publish in-network rates monthly in machine-readable files.","cite":{"label":"Sec. 105","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-HF3DE548260DC44FF9365A74690498CC3"}},{"text":"Requires group health plans, issuers and pharmacy benefit managers to report drug spending, rebate and fee information to the plan at least every 6 months, and sets a civil monetary penalty of $10,000 for each day of a violation.","cite":{"label":"Sec. 106","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-HD06AC933DA3544F082686017C051A6D9"}},{"text":"Requires state Medicaid contracts with pharmacy benefit managers and managed care entities to use a pharmacy price reimbursement model with pass-through payments, and makes spread pricing not allowable for Federal matching payments.","cite":{"label":"Sec. 202","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-HCC954800F0A94AF6BD497AD3DF767E59"}},{"text":"Substitutes, for specified drug administration services furnished by off-campus hospital outpatient departments, the payment amount that would be payable under another applicable payment system under Medicare Part B, phased in over 4 years.","cite":{"label":"Sec. 203","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H06404638F44043A190D2B30D9FA82223"}},{"text":"Extends funding for community health centers, including $4,400,000,000 for fiscal year 2025, and sets teaching health center funding amounts through fiscal year 2030.","cite":{"label":"Sec. 301","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H444947BB5CB94B07A0AB3603BB92F52F"}},{"text":"Requires contracts between group health plans and providers, third-party administrators or pharmacy benefit managers to let the plan fiduciary audit de-identified claims data, and sets a $10,000 penalty for each day of a violation.","cite":{"label":"Sec. 401","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H4480F342AB8E47FDB5A8545369EF7EE5"}}],"unexpected":[{"category":"off_subject","items":[{"cite":{"label":"Sec. 108","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H5DA1B886BFB64E17BC5AC9B91A3C56FB"},"heading":"Report on integration in Medicare","effect":"Requires Medicare Advantage organizations and Part D plan sponsors to report provider and pharmacy ownership and payment information to the Secretary, and requires the Medicare Payment Advisory Commission to report on vertical integration in Medicare.","amount":null,"quote":"each applicable MA organization offering an MA plan under this part during such plan year shall submit to the Secretary, at a time and in a manner specified by the Secretary"},{"cite":{"label":"Sec. 110","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H60F25777CDBD49DAAEF81C78C61BDC13"},"heading":"Report on impact of Medicare regulations on provider and payer consolidation","effect":"Requires an annual Secretary report on the effect of Medicare regulations on provider and payer consolidation, requires public comment on that effect for certain proposed rules, and adds a consolidation factor to Innovation Center model reviews.","amount":null,"quote":"shall submit to Congress a report on the impact in the aggregate on provider and payer consolidation with respect to regulations for parts A, B, C, and D of title XVIII"},{"cite":{"label":"Sec. 201","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H89BEB891C2EE4708971D262A95027C56"},"heading":"Increasing transparency in generic drug applications","effect":"Requires the Secretary to tell generic drug applicants whether a drug is qualitatively and quantitatively the same as the listed drug, to disclose the differing ingredients, and to issue guidance on how that is determined.","amount":null,"quote":"the Secretary shall inform the person whether such drug is qualitatively and quantitatively the same as the listed drug."},{"cite":{"label":"Sec. 303","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H5745735DE908403E9022855F7B78F737"},"heading":"Delaying certain disproportionate share payment cuts","effect":"Changes the Medicaid disproportionate share hospital allotment provision so that its reduction language applies to fiscal years beginning with 2026 instead of the period beginning January 20, 2024 and fiscal year 2025.","amount":null,"quote":"by striking “For the period beginning January 20, 2024, and ending September 30, 2024, and for each of fiscal years 2025” and inserting “For each of fiscal years 2026”"},{"cite":{"label":"Sec. 304","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H8DAB0B1A92654D97B6CCB5CB6428B898"},"heading":"Medicaid improvement fund","effect":"Replaces the $6,357,117,810 figure in the Medicaid improvement fund provision with $0.","amount":"$6,357,117,810","quote":"by striking “ $6,357,117,810” and inserting “$0”"}]},{"category":"selective_carve_out","items":[{"cite":{"label":"Sec. 101","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H2B9674BFCA4C40398B3FEC043F9863F0"},"heading":"Hospital price transparency","effect":"Lets the Secretary waive a hospital price transparency penalty, or reduce it by up to 75 percent, for hospitals in rural or underserved areas when the Secretary certifies the penalty would threaten access to care. Each hospital may receive a waiver and a reduction once per 6-year period.","amount":null,"quote":"the Secretary may waive any penalty, or reduce any penalty by not more than 75 percent, otherwise applicable under this subparagraph with respect to a specified hospital located in a rural or underserved area"},{"cite":{"label":"Sec. 104","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H44612F46DB58436EB001A8FA31F45FC9"},"heading":"Ambulatory surgical center price transparency","effect":"Lets the Secretary waive an ambulatory surgical center price transparency penalty, or reduce it by up to 75 percent, for centers in rural or underserved areas when the Secretary certifies the penalty would threaten access to care. Each center may receive a waiver and a reduction once per 6-year period.","amount":null,"quote":"the Secretary may waive any penalty, or reduce any penalty by not more than 75 percent, otherwise applicable under this subparagraph with respect to an ambulatory surgical center located in a rural or underserved area"},{"cite":{"label":"Sec. 105","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-HF3DE548260DC44FF9365A74690498CC3"},"heading":"Health coverage price transparency","effect":"Requires monthly public posting of rate and payment information by group health plans and issuers, but excludes grandfathered health plans from that posting requirement.","amount":null,"quote":"each group health plan (other than a grandfathered health plan (as defined in section 1251(e) of the Patient Protection and Affordable Care Act)) shall, for each month, not later than the tenth day of such month"},{"cite":{"label":"Sec. 202","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-HCC954800F0A94AF6BD497AD3DF767E59"},"heading":"Improving transparency and preventing the use of abusive spread pricing and related practices in Medicaid","effect":"Sets Medicaid pharmacy reimbursement rules for contracts with pharmacy benefit managers and managed care entities, but lets ingredient-cost payments for 340B drugs bought by covered entities exceed actual acquisition cost, subject to a cap and annual reporting.","amount":null,"quote":"except that any payment by the designated entity or the PBM for the ingredient cost of such a drug purchased by a covered entity (as defined in subsection (a)(5)(B)) may exceed the actual acquisition cost"},{"cite":{"label":"Sec. 203","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H06404638F44043A190D2B30D9FA82223"},"heading":"Parity in Medicare payments for hospital outpatient department services furnished off-campus","effect":"Sets Medicare payment for drug administration services at off-campus hospital outpatient departments equal to the amount under the applicable non-hospital payment system, starting 2025, but starts it a year later and phases in to 2029 for certain hospitals and for rural or health professional shortage areas.","amount":null,"quote":"or is located in a rural area or a health professional shortage area, such services that are furnished during 2026 or a subsequent year"},{"cite":{"label":"Sec. 402","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-HCEF73E9CF0674E38A8B9B83044787BB5"},"heading":"Hidden Fees Disclosure Requirements","effect":"Exempts contracts and arrangements entered into before January 1, 2025 from the new pharmacy benefit manager and third party administrator disclosure requirements in subsection (b).","amount":null,"quote":"No contract or arrangement entered into prior to January 1, 2025, shall be subject to the requirements of subsection (b)."},{"cite":{"label":"Sec. 109","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh#toc-H7987961B3FE047A48B4154C63B1DCBD2"},"heading":"Advisory Committee","effect":"Directs three Secretaries to convene a 9-member advisory committee on price transparency information, ending January 1, 2028, and exempts that committee from the Federal Advisory Committee Act.","amount":null,"quote":"The Federal Advisory Committee Act (5 U.S.C. App.) shall not apply to the committee."}]}],"version":{"type":"Engrossed in House","date":"2023-12-11","rule":"passed","href":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text/eh"},"current":true,"model":"claude-sonnet-5-5","approved":"2026-10-02","approved_by":"checks"},"sources":{"congress_gov":"https://www.congress.gov/bill/118th-congress/house-bill/5378","text":"https://www.congress.gov/bill/118th-congress/house-bill/5378/text"},"card":{"image":"card/item/118-hr-5378.png","v":"72fbe6c9ddfb","alt":"Votes on Record. H.R. 5378, 118th Congress: Lower Costs, More Transparency Act. House: 320 Yea, 71 Nay. Outcome: Passed House, 11 Dec 2023."}}