Great American Healthcare Plan

[Congressional Bills 119th Congress] [From the U.S. Government Publishing Office] [H.R. 8324 Introduced in House (IH)]

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119th CONGRESS 2d Session H. R. 8324

To amend the Internal Revenue Code of 1986 to increase the limitations on contributions to health savings accounts, to amend the Public Health Service Act to provide for hospital and insurer price transparency, and for other purposes.

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IN THE HOUSE OF REPRESENTATIVES

April 16, 2026

Mr. Burlison (for himself and Mr. Barrett) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Workforce, the Judiciary, Armed Services, Veterans' Affairs, and Foreign Affairs, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

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A BILL

To amend the Internal Revenue Code of 1986 to increase the limitations on contributions to health savings accounts, to amend the Public Health Service Act to provide for hospital and insurer price transparency, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title.--This Act may be cited as the ``Great American Healthcare Plan''. (b) Table of Contents.--The table of contents for this Act is as follows:

Sec. 1. Short title; table of contents. TITLE I--HEALTH SAVINGS ACCOUNTS

Sec. 101. Short title. Sec. 102. Increase in contribution limitations. Sec. 103. Freedom from mandate. Sec. 104. Amounts paid for health insurance or direct primary care service arrangement. Sec. 105. Special rule for certain medical expenses incurred before establishment of account. Sec. 106. Administrative error correction before due date of return. Sec. 107. Allowing HSA rollover to child or parent of account holder. Sec. 108. Coverage for amounts paid for healthy food, vitamins, dietary supplements, and sports and fitness expenses. Sec. 109. Equivalent bankruptcy protections for health savings accounts as retirement funds. Sec. 110. Satisfaction of employer mandate through health savings account contributions. Sec. 111. Rollovers from health care FSAs and HRAs permitted. Sec. 112. Qualified general contributions to health savings accounts. Sec. 113. Charitable contributions to health savings accounts. Sec. 114. Amounts paid for health care sharing ministry. TITLE II--HEALTH MARKETPLACE FOR ALL

Sec. 201. Short title. Sec. 202. Health marketplace pools deemed an ``employer'' for purposes of offering group health plans or group health insurance coverage. Sec. 203. Conforming amendments. TITLE III--STRENGTHENING HOSPITAL AND INSURER PRICE TRANSPARENCY

Sec. 301. Short title. Sec. 302. Strengthening hospital price transparency requirements. Sec. 303. Increasing price transparency of clinical diagnostic laboratory tests. Sec. 304. Imaging transparency. Sec. 305. Ambulatory surgical center price transparency requirements. Sec. 306. Strengthening health coverage transparency requirements. Sec. 307. Increasing group health plan access to health data. Sec. 308. Oversight of administrative service providers. Sec. 309. State preemption only in event of conflict. Sec. 310. Requirement for explanation of benefits. Sec. 311. Provision of itemized bills. TITLE IV--PROTECTING PATIENT ACCESS TO CANCER AND COMPLEX THERAPIES

Sec. 401. Short title. Sec. 402. Rebate by manufacturers for selected drugs and biological products subject to maximum fair price negotiation. TITLE V--EXPANDED-ACCESS PRESCRIPTION DRUGS

Sec. 501. Expanded-access prescription drugs. Sec. 502. Government sponsored programs.

TITLE I--HEALTH SAVINGS ACCOUNTS

SEC. 101. SHORT TITLE.

This title may be cited as the ``Health Savings Accounts For All Act of 2026''.

SEC. 102. INCREASE IN CONTRIBUTION LIMITATIONS.

(a) In General.--Subsection (b) of section 223 of the Internal Revenue Code of 1986 is amended-- (1) in paragraph (1), by striking ``the sum of'' and all that follows through the period and inserting ``an amount equal to the applicable dollar amount under paragraph (1)(B) of section 402(g) (as adjusted pursuant to paragraph (4) of such section) with respect to such taxable year.'', (2) by striking paragraphs (2), (3), (5), (7), and (8), (3) by inserting after paragraph (1) the following: ``(2) Additional contributions for individuals 50 or older.--In the case of an individual who has attained age 50 before the close of the taxable year, the amount of the limitation under paragraph (1) shall be increased by an amount equal to the applicable dollar amount under subparagraph (B)(i) of section 414(v)(2) (as adjusted pursuant to subparagraph (C) of such section).'', (4) in paragraph (4), by striking the flush matter following subparagraph (C), and (5) by redesignating paragraphs (4) and (6) as paragraphs (3) and (4), respectively. (b) Conforming Amendments.-- (1) Subparagraph (A) of section 223(d)(1) of the Internal Revenue Code of 1986 is amended by striking ``the sum of--'' and all that follows through the period and inserting ``the amount determined under subsection (b)(1).''. (2) Subsection (g)(1) of section 223 of such Code is amended-- (A) by striking ``(b)(2), (c)(2)(A), and'' and inserting ``(c)(2)(A) and,'', (B) by amending subparagraph (B) to read as follows: ``(B) the cost-of-living adjustment determined under section 1(f)(3) for the calendar year in which such taxable year begins determined by substituting `calendar year 2003' for `calendar year 2016' in subparagraph (A)(ii) thereof.'', and (C) by striking ``(b)(2), (c)(1)(E)(ii)(II),'' and inserting ``(c)(1)(E)(ii)(II)''. (3) Section 26(b)(2)(S) of such Code is amended by striking ``, 223(b)(8)(B)(i)(II),''. (4) Section 408(d)(9)(C)(i)(I) of such Code is amended by striking ``computed on the basis of the type of coverage under the high deductible health plan covering the individual''. (c) Effective Date.--The amendments made by this section shall apply to taxable years beginning after the date of the enactment of this Act.

SEC. 103. FREEDOM FROM MANDATE.

(a) In General.--Section 223 of the Internal Revenue Code of 1986, as amended by section 102, is further amended by striking subsections (c) and (g) and by redesignating subsections (d), (e), (f), and (h) as subsections (c), (d), (e), and (f), respectively. (b) Conforming Amendments.-- (1) Subsection (a) of section 223 of the Internal Revenue Code of 1986 is amended to read as follows: ``(a) Deduction Allowed.--In the case of an individual, there shall be allowed as a deduction for the taxable year an amount equal to the aggregate amount paid in cash during such taxable year by or on behalf of such individual to a health savings account of such individual.''. (2) Subsection (c)(1)(A) of section 223 of such Code, as amended by section 102 and redesignated by subsection (a), is further amended by striking ``subsection (f)(4)'' and inserting ``subsection (e)(4)''. (3) Subparagraph (U) of section 26(b)(2) of such Code, as amended by section 102, is further amended by striking ``section 223(f)(4)'' and inserting ``section 223(e)(4)''. (4) Sections 35(g)(3), 220(f)(5)(A), 848(e)(1)(B)(v), 4973(a)(5), and 6051(a)(12) of such Code are each amended by striking ``section 223(d)'' each place it appears and inserting ``section 223(c)''. (5) Section 106(d)(1) of such Code is amended-- (A) by striking ``who is an eligible individual (as defined in section 223(c)(1))'', and (B) by striking ``section 223(d)'' and inserting ``section 223(c)''. (6) Section 106(e) of such Code is amended-- (A) by striking paragraphs (3) and (4) and by redesignating paragraph (5) as paragraph (4), (B) by inserting after paragraph (2) the following new paragraph: ``(3) Treatment as rollover contribution.--A qualified HSA distribution shall be treated as a rollover contribution described in section 223(e)(5).'', and (C) by striking ``to any eligible individual covered under a high deductible health plan of the employer'' in paragraph (4)(B)(ii) (as so redesignated) and inserting ``to any employee with respect to whom a health savings account has been established''. (7) Section 408(d)(9)(A) of such Code is amended by striking ``who is an eligible individual (as defined in section 223(c)) and''. (8) Section 877A(g)(6) of such Code is amended by striking ``223(f)(4)'' and inserting ``223(e)(4)''. (9) Section 4973(g) of such Code is amended-- (A) by striking ``section 223(d)'' and inserting ``section 223(c)'', (B) in paragraph (1), by striking ``or 223(f)(5)'' and inserting ``or 223(e)(5)'', (C) in paragraph (2)(A), by striking ``section 223(f)(2)'' and inserting ``section 223(e)(2)'', and (D) in the flush matter at the end, by striking ``section 223(f)(3)'' and inserting ``section 223(e)(3)''. (10) Section 4975 of such Code is amended-- (A) in subsection (c)(6)-- (i) by striking ``section 223(d)'' and inserting ``section 223(c)'', and (ii) by striking ``section 223(e)(2)'' and inserting ``section 223(d)(2)'', and (B) in subsection (e)(1)(E), by striking ``section 223(d)'' and inserting ``section 223(c)''. (11) Subsection (b) of section 4980G of such Code is amended to read as follows: ``(b) Rules and Requirements.-- ``(1) In general.--An employer meets the requirements of this subsection for any calendar year if the employer makes available comparable contributions to the health savings accounts of all comparable participating employees for each coverage period during such calendar year. ``(2) Comparable contributions.-- ``(A) In general.--For purposes of paragraph (1), the term `comparable contributions' means contributions-- ``(i) which are the same amount, or ``(ii) if the employees are covered by a health plan, which are the same percentage of the annual deductible limit under the plan covering the employees. ``(B) Part-year employees.--In the case of an employee who is employed by the employer for only a portion of the calendar year, a contribution to the health savings account of such employee shall be treated as comparable if it is an amount which bears the same ratio to the comparable amount (determined without regard to this subparagraph) as such portion bears to the entire calendar year. ``(3) Comparable participating employees.--For purposes of paragraph (1), the term `comparable participating employees' means all employees who are covered (if at all) under the same health plan of the employer and have the same category of coverage. For purposes of the preceding sentence, the categories of coverage are self-only and family coverage. ``(4) Part-time employees.-- ``(A) In general.--Paragraph (3) shall be applied separately with respect to part-time employees and other employees. ``(B) Part-time employee.--For purposes of subparagraph (A), the term `part-time employee' means any employee who is customarily employed for fewer than 30 hours per week.''. (12) Section 4980G(d) of such Code is amended by striking ``section 4980E'' and inserting ``this section''. (13) Section 6693(a)(2)(C) of such Code is amended by striking ``section 223(h)'' and inserting ``section 223(f)''. (c) Effective Date.--The amendments made by this section shall apply to taxable years beginning after the date of the enactment of this Act.

SEC. 104. AMOUNTS PAID FOR HEALTH INSURANCE OR DIRECT PRIMARY CARE SERVICE ARRANGEMENT.

(a) In General.--Paragraph (2) of section 223(c) of the Internal Revenue Code of 1986, as redesignated by section 103, is amended-- (1) in subparagraph (A), by inserting ``or pursuant to an arrangement under which an individual is provided coverage restricted to primary care services in exchange for a fixed periodic fee or payment for primary care services'' after ``menstrual care products'', (2) by striking subparagraphs (B) and (C), and (3) by redesignating subparagraph (D) as subparagraph (B). (b) Conforming Amendment.--Paragraph (2) of section 223(c) of the Internal Revenue Code of 1986, as amended by the preceding sections of this Act, is further amended by striking ``and any dependent (as defined in section 152, determined without regard to subsections (b)(1), (b)(2), and (d)(1)(B) thereof) of such individual'' and inserting ``any dependent (as defined in section 152, determined without regard to subsections (b)(1), (b)(2), and (d)(1)(B) thereof) of such individual, and any child (as defined in section 152(f)(1)) of such individual who has not attained the age of 27 before the end of such individual's taxable year''. (c) Technical Amendments.-- (1) Section 220(d)(2)(A) of the Internal Revenue Code of 1986 is amended by striking ``section 223(d)(2)(D)'' and inserting ``section 223(c)(2)(B)''. (2) Subsection (f) of section 106 of the Internal Revenue Code of 1986 is amended by striking ``section 223(d)(2)(D)'' and inserting ``section 223(c)(2)(B)''. (d) Effective Dates.-- (1) In general.--The amendments made by subsections (a) and (b) shall apply with respect to amounts paid after the date of the enactment of this Act in taxable years beginning after such date. (2) Technical amendments.--The amendments made by subsection (c) shall apply with respect to taxable years beginning after the date of enactment of this Act.

SEC. 105. SPECIAL RULE FOR CERTAIN MEDICAL EXPENSES INCURRED BEFORE ESTABLISHMENT OF ACCOUNT.

(a) In General.--Paragraph (2) of section 223(c) of the Internal Revenue Code of 1986, as amended and redesignated by the preceding sections of this Act, is further amended by adding at the end the following new subparagraph: ``(C) Certain medical expenses incurred before establishment of account treated as qualified.--An expense shall not fail to be treated as a qualified medical expense solely because such expense was incurred before the establishment of the health savings account if such expense was incurred-- ``(i) during either-- ``(I) the taxable year in which the health savings account was established, or ``(II) the preceding taxable year, in the case of a health savings account established after the taxable year in which such expense was incurred but before the time prescribed by law for filing the return for such taxable year (not including extensions thereof), and ``(ii) for medical care which (but for the fact that it was incurred before the establishment of the account) otherwise meets the requirements of the preceding subparagraphs.''. (b) Effective Date.--The amendment made by this section shall apply to taxable years beginning after the date of the enactment of this Act.

SEC. 106. ADMINISTRATIVE ERROR CORRECTION BEFORE DUE DATE OF RETURN.

(a) In General.--Paragraph (4) of section 223(e) of the Internal Revenue Code of 1986, as amended and redesignated by the preceding sections of this Act, is amended by adding at the end the following new subparagraph: ``(D) Exception for administrative errors corrected before due date of return.--Subparagraph (A) shall not apply if any payment or distribution is made to correct an administrative, clerical, or payroll contribution error and if-- ``(i) such distribution is received by the individual on or before the last day prescribed by law (including extensions of time) for filing such individual's return for such taxable year, and ``(ii) such distribution is accompanied by the amount of net income attributable to such contribution. Any net income described in clause (ii) shall be included in the gross income of the individual for the taxable year in which it is received.''. (b) Effective Date.--The amendment made by this section shall take effect on the date of the enactment of this Act.

SEC. 107. ALLOWING HSA ROLLOVER TO CHILD OR PARENT OF ACCOUNT HOLDER.

(a) In General.--Paragraph (8)(A) of section 223(e) of the Internal Revenue Code of 1986, as redesignated by the preceding sections of this Act, is amended-- (1) by inserting ``, child, parent, or grandparent'' after ``surviving spouse'', (2) by inserting ``, child, parent, or grandparent, as the case may be,'' after ``the spouse'', (3) by inserting ``, child, parent, or grandparent'' after ``spouse'' in the heading thereof, and (4) by adding at the end the following: ``In the case of a child who acquires such beneficiary's interest and with respect to whom a deduction under section 151 is allowable to another taxpayer for a taxable year beginning in the calendar year in which such individual's taxable year begins, such health savings account shall be treated as a health savings account of such child.''. (b) Effective Date.--The amendments made by this section shall apply to taxable years beginning after the date of the enactment of this Act.

SEC. 108. COVERAGE FOR AMOUNTS PAID FOR HEALTHY FOOD, VITAMINS, DIETARY SUPPLEMENTS, AND SPORTS AND FITNESS EXPENSES.

(a) In General.--Paragraph (2) of section 223(c) of the Internal Revenue Code of 1986, as amended by the preceding provisions of this Act, is amended-- (1) in subparagraph (A), by adding at the end the following new sentence: ``For purposes of this subparagraph, amounts paid for qualified wellness expenses shall be treated as paid for medical care, but only to the extent that such amounts paid with respect to each individual described in the first sentence of this subparagraph do not exceed $100 per month in the case of a health savings account the balance of which does not exceed $5,000; $150 per month in the case of a health savings account the balance of which exceeds $5,000 but does not exceed $10,000; and $200 per month in the case of a health savings account the balance of which exceeds $10,000.'', and (2) by adding at the end the following: ``(D) Qualified wellness expenses.-- ``(i) In general.--For purposes of this paragraph, the term `qualified wellness expenses' means amounts paid for healthy food, vitamins, dietary supplements (as defined in section 201(ff) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 321(ff))), or qualified sports and fitness expenses. ``(ii) Healthy food.--The term `healthy food' means any individual food which meets the criteria of section 101.65(d)(3)(i) of title 21, Code of Federal Regulations (or any successor regulations). ``(iii) Qualified sports and fitness expenses.-- ``(I) In general.--The term `qualified sports and fitness expenses' means amounts paid exclusively for the sole purpose of participating in a physical activity, including-- ``(aa) for membership at a fitness facility, ``(bb) for participation or instruction in physical exercise or physical activity, or ``(cc) for equipment used in a program (including a self- directed program) of physical exercise or physical activity, including a wearable fitness tracker. ``(II) Fitness facility.--For purposes of subclause (I)(aa), the term `fitness facility' means a facility-- ``(aa) which provides instruction in a program of physical exercise, offers facilities for the preservation, maintenance, encouragement, or development of physical fitness, or serves as the site of such a program of a State or local government or an organization described in section 501(c)(3) and exempt from tax under section 501(a), ``(bb) which is not a private club owned and operated by its members, ``(cc) which does not offer golf, hunting, sailing, or riding facilities, ``(dd) the health or fitness component of which is not incidental to its overall function and purpose, and ``(ee) which is fully compliant with the State of jurisdiction and Federal anti- discrimination laws. ``(III) Treatment of exercise videos, etc.--Videos, books, and similar materials shall be treated as described in subclause (I)(bb) if the content of such materials constitutes instruction in a program of physical exercise or physical activity. ``(IV) Limitations related to sports and fitness equipment.--Amounts paid for equipment described in subclause (I)(cc) shall be treated as qualified sports and fitness expenses only-- ``(aa) if such equipment is utilized exclusively for participation in fitness, exercise, sport, or other physical activity, and ``(bb) in the case of amounts paid for apparel or footwear, if such apparel or footwear is of a type that is necessary for, and is not used for any purpose other than, a specific physical activity.''. (b) Effective Date.--The amendments made by this section shall apply to taxable years beginning after the date of the enactment of this Act.

SEC. 109. EQUIVALENT BANKRUPTCY PROTECTIONS FOR HEALTH SAVINGS ACCOUNTS AS RETIREMENT FUNDS.

(a) In General.--Section 522 of title 11, United States Code, is amended by adding at the end the following new subsection: ``(r) Treatment of Health Savings Accounts.--For purposes of this section, any health savings account (as described in section 223 of the Internal Revenue Code of 1986) shall be treated in the same manner as an individual retirement account described in section 408 of such Code.''. (b) Effective Date.--The amendment made by this section shall apply to cases commencing under title 11, United States Code, after the date of the enactment of this Act.

SEC. 110. SATISFACTION OF EMPLOYER MANDATE THROUGH HEALTH SAVINGS ACCOUNT CONTRIBUTIONS.

(a) In General.--Section 4980H of the Internal Revenue Code of 1986 is amended by adding at the end the following new subsection: ``(e) Contributions to Health Savings Accounts.-- ``(1) In general.--An offer to make a contribution of $450 per month to an employee's health savings account shall be treated for purposes of this section as an offer to enroll in minimum essential coverage under an eligible employer-sponsored plan for such month. ``(2) Treatment as affordable coverage.--Any employee offered a contribution described in paragraph (1) by any employer for any month shall not be treated as described in subsection (b)(1)(B) with respect to such employer for such month.''. (b) Application of Exclusion for Employer Contributions to Health Savings Accounts.--Section 106(d) of such Code is amended-- (1) by redesignating paragraphs (2) and (3) as paragraphs (3) and (4), respectively, and (2) by inserting after paragraph (1) the following new paragraph: ``(2) Limitation.--In the case of an employee whose employer makes a contribution of at least $450 per month to such employee's health savings account, paragraph (1) shall apply to such a contribution only if such employee is enrolled in health care coverage for such month.''. (c) Effective Date.--The amendments made by this section shall apply to months beginning in taxable years beginning after the date of the enactment of this Act.

SEC. 111. ROLLOVERS FROM HEALTH CARE FSAS AND HRAS PERMITTED.

(a) In General.--Section 106 of the Internal Revenue Code of 1986 is amended by adding at the end the following new subsection: ``(h) FSA and HRA Rollovers to Health Savings Accounts.-- ``(1) In general.--A plan shall not fail to be treated as a health flexible spending arrangement or health reimbursement arrangement under this section or section 105 merely because such plan provides for a qualified HSA rollover distribution. ``(2) Qualified hsa rollover distribution.--For purposes of this subsection, the term `qualified HSA rollover distribution' means any portion of a beneficiary's unused balance of a health flexible spending arrangement or health reimbursement arrangement at the end of any plan year (or such other times as the Secretary may provide) which is transferred in a direct trustee-to-trustee transfer to a health savings account of such beneficiary. ``(3) Treatment as hsa rollover contribution.--For purposes of this title, a qualified HSA rollover distribution shall be treated as a contribution described in section 223(e)(5).''. (b) Effective Date.--The amendment made by this section shall apply to taxable years beginning after the date of the enactment of this Act.

SEC. 112. QUALIFIED GENERAL CONTRIBUTIONS TO HEALTH SAVINGS ACCOUNTS.

(a) In General.--Section 223 of the Internal Revenue Code of 1986, as amended by the preceding provisions of this Act, is amended-- (1) in subsection (c)(1)(A), by inserting ``or a qualified general contribution,'' after ``section 220(f)(5),'', and (2) in subsection (e)-- (A) in paragraph (3)(B), by inserting ``, or a qualified general contribution'' after ``section 220(f)(5)'', and (B) by adding at the end the following new paragraph: ``(9) Qualified general contribution.--For purposes of this section-- ``(A) In general.--The term `qualified general contribution' means any contribution which-- ``(i) is made by the Secretary pursuant to a general funding contribution, ``(ii) is made to the health savings account of an account beneficiary in the qualified class of account beneficiaries specified in the general funding contribution, and ``(iii) is in an amount which is equal to the ratio of-- ``(I) the amount of such general funding contribution, to ``(II) the number of account beneficiaries in such qualified class. ``(B) General funding contribution.--The term `general funding contribution' means a contribution which-- ``(i) is made by-- ``(I) an entity described in section 170(c)(1) (other than a possession of the United States or a political subdivision thereof) or an Indian tribal government, or ``(II) an organization described in section 501(c)(3) and exempt from tax under section 501(a), and ``(ii) which specifies a qualified class of account beneficiaries to whom such contribution is to be distributed. ``(C) Qualified class.-- ``(i) In general.--The term `qualified class' means any of the following: ``(I) All account beneficiaries. ``(II) All account beneficiaries who reside in one or more States or other qualified geographic areas specified by the terms of the general funding contribution. ``(ii) Qualified geographic area.--The term `qualified geographic area' means any geographic area in which not less than 5,000 account beneficiaries reside and which is designated by the Secretary as a qualified geographic area under this clause.''. (b) Exclusion From Gross Income.-- (1) In general.--Part III of subchapter B of chapter 1 of such Code is amended by inserting before section 140 the following new section:

``SEC. 139M. QUALIFIED GENERAL CONTRIBUTIONS TO HEALTH SAVINGS ACCOUNTS.

``(a) In General.--Gross income of an account beneficiary shall not include any qualified general contribution to a health savings account of the account beneficiary. ``(b) Definitions.--Any term used in this section which is used in section 223 shall have the meaning given such term under section 223.''. (2) Clerical amendment.--The table of sections for part III of subchapter B of chapter 1 of such Code is amended by inserting before the item relating to section 140 the following new item:

``Sec. 139M. Qualified general contributions to health savings accounts.''. (c) Effective Date.--The amendments made by this section shall apply to taxable years beginning after the date of the enactment of this Act.

SEC. 113. CHARITABLE CONTRIBUTIONS TO HEALTH SAVINGS ACCOUNTS.

(a) In General.--Section 223(c)(1) of the Internal Revenue Code of 1986, as amended by the preceding provisions of this Act, is amended by adding at the end the following new subparagraph: ``(F) The trustee provides the account beneficiary with a URL (or other similar shareable link) which allows any organization described in section 501(c)(3) and exempt from tax under section 501(a) to make contributions to the account on the account beneficiary's behalf. Any such contribution shall be taken into account as a charitable contribution for purposes of section 170 to the extent that the aggregate amount of such contributions from each such organization for any taxable year does not exceed $5,000.''. (b) Effective Date.--The amendment made by this section shall apply to taxable years beginning after the date of the enactment of this Act.

SEC. 114. AMOUNTS PAID FOR HEALTH CARE SHARING MINISTRY.

(a) In General.--Section 223(c)(2)(A) of the Internal Revenue Code of 1986, as amended by the preceding provisions of this Act, is amended by adding at the end the following new sentence: ``For purposes of this subparagraph, amounts paid by a member of a health care sharing ministry (as defined in section 5000A(d)(2)(B)(ii) without regard to subclause (IV) thereof) for the sharing of medical expenses among members, or administrative fees of such ministry, shall be treated as paid for medical care.''. (b) Effective Date.--The amendment made by this section shall apply to taxable years beginning after the date of the enactment of this Act.

TITLE II--HEALTH MARKETPLACE FOR ALL

SEC. 201. SHORT TITLE.

This title may be cited as the ``Health Marketplace for All Act of 2026''.

SEC. 202. HEALTH MARKETPLACE POOLS DEEMED AN ``EMPLOYER'' FOR PURPOSES OF OFFERING GROUP HEALTH PLANS OR GROUP HEALTH INSURANCE COVERAGE.

(a) Definition of Employer.--Section 3(5) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1002(5)) is amended by adding at the end the following: ``Such term shall be deemed to include, for purposes of offering a group health plan (as defined in section 733(a)(1)) or group health insurance coverage (as defined in section 733(b)(4)) (which, notwithstanding any other provision of law, may include such a plan or coverage covering prescription or nonprescription drugs as the only benefit offered by the plan or coverage in accordance with section 736(b)(5)(B)), any entity that meets the requirements under section 736(b).''. (b) Group Health Plans and Group Health Insurance Coverage.--Part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1181 et seq.) is amended by adding at the end the following:

``SEC. 736. HEALTH MARKETPLACE POOLS DEEMED AN `EMPLOYER' FOR PURPOSES OF OFFERING GROUP HEALTH PLANS OR GROUP HEALTH INSURANCE COVERAGE.

``(a) In General.--An entity (referred to in this section as a `health marketplace pool') that meets the requirements under subsection (b) shall be deemed an employer under section 3(5) for purposes of offering a group health plan or group health insurance coverage (which, notwithstanding any other provision of law, may include such a plan or coverage covering prescription or nonprescription drugs as the only benefit offered by the plan or coverage in accordance with subsection (b)(5)(B)). ``(b) Requirements for Health Marketplace Pools.--The requirements under this subsection are each of the following: ``(1) Organization.--The health marketplace pool shall-- ``(A) be formed and maintained in good faith for a purpose that includes the formation of a risk pool in order to offer group health insurance coverage or a group health plan to its members; and ``(B) not condition membership in the health marketplace pool on any health status-related factor relating to an individual (including an employee of an employer or a dependent of an employee). ``(2) Offering group health plans and group health insurance coverage.-- ``(A) Different groups.-- ``(i) In general.--The health marketplace pool, which may be in conjunction with a health insurance issuer that offers group health insurance coverage through the health marketplace pool, shall make available a group health plan or group health insurance coverage to all members of the health marketplace pool (and, in the case of members that are employers, employees of the employers) at rates that-- ``(I) are established by the health marketplace pool, or a health insurance issuer contracting with such health marketplace pool, on a policy or product specific basis; and ``(II) subject to sections 701 and 702, may vary for individuals covered through the health marketplace pool. ``(ii) Permissible coverage for dependents.--Such group health plan or group health insurance coverage may be made available under clause (i) to any dependents of members of the health marketplace pool or dependents of employees of employers that are such members. ``(B) Nondiscrimination in coverage offered.-- ``(i) In general.--Subject to clause (ii), the health marketplace pool may not offer coverage under a group health plan or group health insurance coverage to a member of the health marketplace pool unless the same coverage is offered to all such members of the health marketplace pool. ``(ii) Construction.--Nothing in this subsection shall be construed as requiring a health insurance issuer or group health plan to provide coverage outside the service area of the issuer or plan, or preventing a health insurance issuer or group health plan from underwriting or from excluding or limiting the coverage on any individual, subject to the requirements under sections 701 and 702. ``(C) Assumption of risk.--The health marketplace pool may provide-- ``(i) group health insurance coverage through a contract with a health insurance issuer; or ``(ii) a group health plan through self- insurance. ``(3) Geographic areas.--Nothing in this subsection shall be construed as preventing the establishment and operation of more than 1 health marketplace pool in a geographic area or as limiting the number of health marketplace pools that may operate in any area. ``(4) Provision of administrative services to purchasers.-- The health marketplace pool may provide administrative services for members. Such services may include accounting, billing, and enrollment information. ``(5) Drug coverage.--The group health plan or group health insurance coverage offered by the health marketplace pool may offer-- ``(A) drug coverage, including coverage of over- the-counter drugs, in combination with other benefits covered by the group health plan or group health insurance coverage; or ``(B) notwithstanding any other provision of law, drug coverage, including coverage of over-the-counter drugs, as the only benefit covered by the group health plan or group health insurance coverage. ``(6) Members.-- ``(A) In general.--With respect to an individual who is a member of the health marketplace pool-- ``(i) the individual may enroll for coverage under the group health plan or group health insurance coverage offered by the health marketplace pool (including, if applicable, enrollment for coverage for a dependent of such individual); or ``(ii) the employer of the individual may enroll the individual for coverage under the group health plan or group health insurance coverage offered by the health marketplace pool (including, if applicable, enrollment for coverage for a dependent of such individual). ``(B) Eligibility.--An individual shall be eligible to be a member of the health marketplace pool if such individual is-- ``(i) a member of an entity that establishes or joins the health marketplace pool (or a dependent of such a member, as applicable); ``(ii) an employee of a member of an entity described in clause (i) (or a dependent of such an employee, as applicable); or ``(iii) an employee of an entity (or a dependent of such an employee, as applicable) controlled by a member of an entity described in clause (i). ``(C) Rules for enrollment.--Nothing in this paragraph shall preclude the health marketplace pool from establishing rules of enrollment and reenrollment of members. Such rules shall be applied consistently to all members within the health marketplace pool and shall not be based in any manner on health status- related factors in accordance with sections 701 and 702. ``(c) Determination of Employer and Joint Employer Status.-- Participating in or facilitating a group health plan or group health insurance coverage under this section shall not be construed as establishing under any Federal or State law-- ``(1) an employer relationship for any purpose other than offering the group health plan or group health insurance coverage; or ``(2) a joint employer relationship for any purpose. ``(d) Definition.--In this section, the term `dependent', as applied to a group health plan or group health insurance coverage offered in a State, shall have the meaning applied to such term with respect to such plan or coverage under the State law applying to such plan or coverage. Such term may include the spouse and children of the individual involved in accordance with such State law.''.

SEC. 203. CONFORMING AMENDMENTS.

Section 3 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1002) is amended-- (1) in paragraph (6), by inserting before the period ``, except (with respect to an entity meeting the requirements under section 736(b)) such term includes any member of such entity''; (2) in paragraph (21)-- (A) in subparagraph (A), by striking ``subparagraph (B)'' and inserting ``subparagraphs (B) and (C)''; and (B) by adding at the end the following: ``(C) With respect to a person that is a member of an entity (referred to in section 736 and this subparagraph as a `health marketplace pool') that meets the requirements of section 736(b) and offers a group health plan (as defined in section 733(a)(1)) or group health insurance coverage (as defined in section 733(b)(4)) (which, notwithstanding any other provision of law, may include such a plan or coverage covering prescription or nonprescription drugs as the only benefit offered by the plan or coverage), membership in the health marketplace pool shall not by itself cause the person to be a fiduciary with respect to the group health plan or group health insurance coverage.''; and (3) in paragraph (40)(A)-- (A) in clause (ii), by striking ``, or'' and inserting ``,''; (B) in clause (iii), by striking the period and inserting ``, or''; and (C) by adding at the end the following: ``(iv) as a group health plan (as defined in section 733(a)(1)), or group health insurance coverage (as defined in section 733(b)(4)), offered by an entity meeting the requirements under section 736(b) (which, notwithstanding any other provision of law, may include such an entity offering such a plan or coverage covering prescription or nonprescription drugs as the only benefit offered by the plan or coverage).''.

TITLE III--STRENGTHENING HOSPITAL AND INSURER PRICE TRANSPARENCY

SEC. 301. SHORT TITLE.

This title may be cited as the ``Patients Deserve Price Tags Act''.

SEC. 302. STRENGTHENING HOSPITAL PRICE TRANSPARENCY REQUIREMENTS.

(a) In General.--Section 2718(e) of the Public Health Service Act (42 U.S.C. 300gg-18(e)) is amended to read as follows: ``(e) Standard Hospital Charges.-- ``(1) In general.-- ``(A) Disclosure of standard charges.--Each hospital shall, in accordance with a method and format established by the Secretary under subparagraph (C), on a monthly basis compile and make public (without subscription and free of charge)-- ``(i) all of the hospital's standard charges (including the information described in subparagraph (B)) for each item and service furnished by such hospital; and ``(ii) hospital standard charge information, including the information described in subparagraph (B), in a consumer- friendly format (as specified by the Secretary), that includes-- ``(I) as many of the Centers for Medicare & Medicaid Services-specified shoppable services that are furnished by the hospital, and as many additional hospital-selected shoppable services (or all such additional services, if such hospital furnishes fewer than 300 shoppable services) as may be necessary for a combined total of at least 300 shoppable services through December 31, 2027, after which the hospital's prices shall include all shoppable services; and ``(II) with respect to each Centers for Medicare & Medicaid Services- specified shoppable service that is not furnished by the hospital, an indication that such service is not so furnished. ``(B) Standard charges described.--For purposes of subparagraph (A), standard charges means: ``(i) A plain language description of each item or service, accompanied by any applicable billing codes, including modifiers, using commonly recognized billing code sets, including the Current Procedural Terminology code, the Healthcare Common Procedure Coding System code, the diagnosis-related group, the National Drug Code, and other nationally recognized identifier. ``(ii) The gross charge, expressed as a dollar amount, for each such item or service, when provided in, as applicable, the inpatient setting and outpatient department setting. ``(iii) The discounted cash price expressed as a dollar amount, for each such item or service when provided in, as applicable, the inpatient setting and outpatient department setting (or, in the case no discounted cash price is available for an item or service, the minimum cash price accepted by the hospital from self-pay individuals for such item or service, expressed as a dollar amount, as well as, with respect to prices made public pursuant to subparagraph (A)(ii), a link to a consumer- friendly document that clearly explains the hospital's charity care policy). The hospital shall accept the discounted cash price as payment in full from any patient that chooses to pay in cash without regard to the patient's coverage. ``(iv) The payer-specific negotiated charges, expressed as a dollar amount and clearly associated with the name of the applicable third party payer and name of each plan, that apply to each such item or service when provided in, as applicable, the inpatient setting and outpatient department setting. If the charges are based on an algorithm, percentage of another amount, or other formula or criteria, the hospital also shall disclose such algorithm, percentage, formula, or criteria as set forth in its contract and any other terms, schedules, exhibits, data, or other information referenced in any such contract as shall be required to determine and disclose the negotiated charge. ``(v) The de-identified maximum and minimum negotiated charges for each such item or service, expressed as a non-zero dollar amount. ``(vi) Any other additional information the Secretary may require for the purpose of improving the accuracy of, or enabling consumers to easily understand and compare, standard charges and prices for an item or service, except information that is duplicative of any other reporting requirement under this subsection. In the case of standard charges and prices for an item or service included as part of a bundled, per diem, episodic, or other similar arrangement, the information described in this subparagraph shall be made available as determined appropriate by the Secretary. ``(C) Uniform method and format.--Not later than January 1, 2027, the Secretary shall establish a standard, uniform method and format for hospitals to use in compiling and making public standard charges pursuant to subparagraph (A)(i) and a standard, uniform method and format for such hospitals to use in compiling and making public prices pursuant to subparagraph (A)(ii). Such methods and formats shall-- ``(i) in the case of such method and format for making public standard charges pursuant to subparagraph (A)(i), ensure that such charges are made available in a machine-readable spreadsheet format; ``(ii) meet such standards as determined appropriate by the Secretary in order to ensure the accessibility and usability of such charges and prices; and ``(iii) be updated as determined appropriate by the Secretary, in consultation with stakeholders. ``(2) No deemed compliance.--The availability of a price estimator tool shall not be considered to deem compliance with or otherwise vitiate the requirements of paragraph (1)(A)(ii) or any other requirements of this section. Furthermore, the use of an estimator tool shall not be used for purposes of compliance with any provisions in this section. ``(3) Monitoring compliance.--The Secretary shall, in consultation with the Inspector General of the Department of Health and Human Services, establish a process to monitor compliance with this subsection. Such process shall ensure that each hospital's compliance with this subsection is reviewed not less frequently than once every year. ``(4) Attestation.--A senior official from each hospital (the Chief Executive Officer, Chief Financial Officer, or an official of equivalent seniority) shall attest to the accuracy and completeness of the disclosures made in accordance with the hospital price transparency requirements set forth in this regulation. Such attestation shall be deemed to be material to payment from the Federal Government to the hospital. ``(5) Enforcement.-- ``(A) In general.--In the case of a hospital that fails to comply with the requirements of this subsection, not later than 30 days after the date on which the Secretary determines such failure exists, the Secretary shall submit to such hospital a notification of such determination, which shall include a request for a corrective action plan to comply with such requirements. ``(B) Civil monetary penalty.-- ``(i) In general.--In addition to any other enforcement actions or penalties that may apply under another provision of law, a hospital that has received a request for a corrective action plan under subparagraph (A) and fails to comply with the requirements of this subsection by the date that is 45 days after such request is made shall be subject to a civil monetary penalty of an amount specified by the Secretary for each day (beginning with the day on which the Secretary first determined that such hospital was not complying with such requirements) during which such failure was ongoing. Such amount shall not exceed-- ``(I) in the case of a hospital with 30 or fewer beds, $300 per day; ``(II) in the case of a hospital with more than 30 beds but fewer than 101 beds, $12.50 per bed per day (or, in the case of such a hospital that has been noncompliant with such requirements for a 1-year period or longer, beginning with the first day following such 1-year period, $15 per bed per day); ``(III) in the case of a hospital with more than 100 beds but fewer than 301 beds, $17.50 per bed per day (or, in the case of such a hospital that has been noncompliant with such requirements for a 1-year period or longer, beginning with the first day following such 1-year period, $20 per bed per day); ``(IV) in the case of a hospital with more than 300 beds but fewer than 501 beds, $20 per bed per day (or, in the case of such a hospital that has been noncompliant with such requirements for a 1-year period or longer, beginning with the first day following such 1-year period, $25 per bed per day); and ``(V) in the case of a hospital with more than 500 beds, $25 per bed per day (or, in the case of such a hospital that has been noncompliant with such requirements for a 1-year period or longer, beginning with the first day following such 1-year period, $35 per bed per day). ``(ii) Increase authority.--In applying this subparagraph with respect to violations occurring in 2028 or a subsequent year, the Secretary may through notice and comment rulemaking increase-- ``(I) the limitation on the per day amount of any penalty applicable to a hospital under clause (i)(I); ``(II) the limitations on the per bed per day amount of any penalty applicable under any of subclauses (II) through (V) of clause (i); and ``(III) the limitation on the increase of any penalty applied under clause (iii) pursuant to the amounts specified in subclause (II) of such clause. ``(iii) Persistent noncompliance.-- ``(I) In general.--In the case of a hospital that the Secretary has determined to be knowingly and willfully noncompliant with the provisions of this subsection two or more times during a 1-year period, the Secretary may increase any penalty otherwise applicable under this subparagraph by the amount specified in subclause (II) with respect to such hospital and may require such hospital to complete such additional corrective actions plans as the Secretary may specify. ``(II) Specified amount.--For purposes of subclause (I), the amount specified in this subclause is, with respect to a hospital-- ``(aa) with more than 30 beds but fewer than 101 beds, an amount that is not less than $500,000 and not more than $1,000,000; ``(bb) with more than 100 beds but fewer than 301 beds, an amount that is greater than $1,000,000 and not more than $2,000,000; ``(cc) with more than 300 beds but fewer than 501 beds, an amount that is greater than $2,000,000 and not more than $4,000,000; and ``(dd) with more than 500 beds, an amount that is not less than $5,000,000 and not more than $10,000,000. ``(iv) Provision of technical assistance.-- The Secretary may, to the extent practicable, provide technical assistance relating to compliance with the provisions of this section to hospitals requesting such assistance. ``(v) Application of certain provisions.-- The provisions of section 1128A (other than subsections (a) and (b) of such section) shall apply to a civil monetary penalty imposed under this subparagraph in the same manner as such provisions apply to a civil monetary penalty imposed under subsection (a) of such section. ``(C) No waiver.--The Secretary shall not grant or extend any waiver, delay, tolling, or other mitigation of a civil monetary penalty for violation of this subsection. ``(6) Definitions.--For purposes of this subsection: ``(A) Discounted cash price.--The term `discounted cash price' means the minimum charge, exclusive of any hospital or third-party payer assistance, that the hospital accepts from an individual who pays cash, or cash equivalent, for a hospital-furnished item or service, without regard to patient coverage, as payment in full. ``(B) Gross charge.--The term `gross charge' means the charge for an individual item or service that is reflected on a hospital's chargemaster, absent any discounts. ``(C) Hospital.--The term `hospital' means a hospital (as defined in section 1861(e) of the Social Security Act), a critical access hospital (as defined in section 1861(mmm)(1) of the Social Security Act), or a rural emergency hospital (as defined in section 1861(kkk) of the Social Security Act), together with any parent, subsidiary, or other affiliated provider or supplier of health care items and services without regard to whether such parent, subsidiary, or other affiliated provider or supplier operates under separate licensure, certification, or designation. ``(D) Payer-specific negotiated charge.--The term `payer-specific negotiated charge' means the charge that a hospital has negotiated with a third party payer for an item or service. ``(E) Shoppable service.--The term `shoppable service' means a service that can be scheduled by a health care consumer in advance and includes all ancillary items and services customarily furnished as part of such service. ``(F) Third party payer.--The term `third party payer' means an entity that is, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service. ``(7) Rulemaking.--The Secretary shall implement this subsection through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''. (b) Effective Date.-- (1) In general.--The amendment made by subsection (a) shall apply beginning January 1, 2027. (2) Continued applicability of rules for previous years.-- Nothing in the amendment made by this section may be construed as affecting the applicability of the regulations codified at part 180 of title 45, Code of Federal Regulations, before January 1, 2026. (c) Continued Applicability of State Law.--The provisions of this Act shall not supersede any provision of State law that establishes, implements, or continues in effect any requirement or prohibition related to health care price transparency, except to the extent that such requirement or prohibition prevents the application of a requirement or prohibition of this Act.

SEC. 303. INCREASING PRICE TRANSPARENCY OF CLINICAL DIAGNOSTIC LABORATORY TESTS.

Section 2718 of the Public Health Service Act (42 U.S.C. 300gg-18) is amended by adding at the end the following: ``(f) Clinical Diagnostic Laboratory Price Transparency.-- ``(1) In general.--Beginning July 1, 2028, an applicable laboratory shall-- ``(A) make publicly available on an internet website the information described in paragraph (2) with respect to each such specified clinical diagnostic laboratory test that such laboratory so furnishes; and ``(B) ensure that such information is updated not less frequently than monthly, if there have been any changes to such information. ``(2) Information described.--For purposes of paragraph (1), the information described in this paragraph is, with respect to an applicable laboratory and a specified clinical diagnostic laboratory test, the following: ``(A) A plain language description of each item or service, accompanied by any applicable billing codes, including modifiers, using commonly recognized billing code sets, including the Current Procedural Terminology code, the Healthcare Common Procedure Coding System code, the diagnosis-related group, the National Drug Code, and other nationally recognized identifier. ``(B) The gross charge expressed as a dollar amount, for each such item or service. ``(C) The discounted cash price expressed as a dollar amount, for each such item or service (or, in the case no discounted cash price is available for an item or service, the minimum cash price accepted by the laboratory from self-pay individuals for such item or service when provided in such settings for the previous three years, expressed as a dollar amount, as well as, with respect to prices made public pursuant to subparagraph (A)(ii), a link to a consumer-friendly document that clearly explains the laboratory's charity care policy). The laboratory shall accept the discounted or minimum cash price as payment in full from any patient that chooses to pay in cash without regard to the patient's coverage. ``(D) The payer-specific negotiated charges, expressed as a dollar amount and clearly associated with the name of the applicable third party payer and name of each plan, that apply to each such item or service when provided in, as applicable, the inpatient setting and outpatient department setting. If the charges are based on an algorithm, percentage of another amount, or other formula or criteria, the clinical diagnostic laboratory also shall disclose such algorithm, percentage, formula, or criteria as set forth in its contract and any other terms, schedules, exhibits, data, or other information referenced in any such contract as shall be required to determine and disclose the negotiated charge. ``(E) The de-identified maximum and minimum negotiated charges for each such item or service, expressed as a non-zero dollar amount. ``(F) Any other additional information the Secretary may require for the purpose of improving the accuracy of, or enabling consumers to easily understand and compare, standard charges and prices for an item or service, except information that is duplicative of any other reporting requirement under this subsection. In the case of standard charges and prices for an item or service included as part of a bundled, per diem, episodic, or other similar arrangement, the information described in this subparagraph shall be made available as determined appropriate by the Secretary. ``(3) Uniform method and format.--Not later than January 1, 2028, the Secretary shall establish a standard, uniform method and format for applicable laboratories to use in compiling and making public information pursuant to paragraph (1). Such method and format shall-- ``(A) include a machine-readable spreadsheet format containing the information described in paragraph (2) for all items and services furnished by each laboratory; ``(B) meet such standards as determined appropriate by the Secretary in order to ensure the accessibility and usability of such information; and ``(C) be updated as determined appropriate by the Secretary, in consultation with stakeholders. ``(4) Inclusion of ancillary services.--Any price or rate for a specified clinical diagnostic laboratory test available to be furnished by an applicable laboratory made publicly available in accordance with paragraph (1) shall include the price or rate for any ancillary item or service (including specimen collection services, specimen transport, centrifugation, aliquoting, labeling, requisition processing, and standard result reporting services) that would customarily and routinely be furnished by such laboratory as part of such test, as specified by the Secretary. ``(5) Enforcement.-- ``(A) In general.--In the case that the Secretary determines that an applicable laboratory is not in compliance with paragraph (1)-- ``(i) not later than 30 days after such determination, the Secretary shall notify such laboratory of such determination; and ``(ii) if such laboratory continues to fail to comply with such paragraph after the date that is 90 days after such notification is sent, the Secretary may impose a civil monetary penalty in an amount not to exceed $300 for each day (beginning with the day on which the Secretary first determined that such laboratory was failing to comply with such paragraph) during which such failure is ongoing. ``(B) Increase authority.--In applying this paragraph with respect to violations occurring in 2029 or a subsequent year, the Secretary may through notice and comment rulemaking increase the per day limitation on civil monetary penalties under subparagraph (A)(ii). ``(C) Application of certain provisions.--The provisions of section 1128A of the Social Security Act (other than subsections (a) and (b) of such section) shall apply to a civil monetary penalty imposed under this paragraph in the same manner as such provisions apply to a civil monetary penalty imposed under subsection (a) of such section. ``(6) Provision of technical assistance.--The Secretary shall, to the extent practicable, provide technical assistance relating to compliance with the provisions of this subsection to applicable laboratories requesting such assistance. ``(7) Definitions.--In this subsection: ``(A) Applicable laboratory.--The term `applicable laboratory' means a `laboratory' as such term is defined in section 493.2, of title 42, Code of Federal Regulations (or a successor regulation), except that such term does not include a laboratory with respect to which standard charges and prices for specified clinical diagnostic laboratory tests furnished by such laboratory are made available by a hospital pursuant to subsection (e) of this section. ``(B) Discounted cash price.--The term `discounted cash price' means the charge that applies to an individual who pays cash, or cash equivalent, for an item or service. ``(C) Gross charge.--The term `gross charge' means the charge for an individual item or service that is reflected on an applicable laboratory's chargemaster, absent any discounts. ``(D) Payer-specific negotiated charge.--The term `payer-specific negotiated charge' means the charge that an applicable laboratory has negotiated with a third party payer for an item or service. ``(E) Specified clinical diagnostic laboratory test.--The term `specified clinical diagnostic laboratory test' means a clinical diagnostic laboratory test that is included on the list of shoppable services specified by the Centers for Medicare & Medicaid Services (as described in subsection (e) of this section), other than such a test that is only available to be furnished by a single provider of services or supplier. ``(F) Third party payer.--The term `third party payer' means an entity that is, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service. ``(8) Rulemaking.--The Secretary shall implement this subsection through notice and comment rulemaking in accordance with section 553 of title 5, United States Code.''.

SEC. 304. IMAGING TRANSPARENCY.

Section 2

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