Texas hospitals must meet the federal machine-readable file (MRF) requirement under 45 CFR 180.50 — and Texas layers its own rules on top: Texas HB 2253 requires hospitals to provide standard charge information upon request and to post certain pricing data — in addition to the federal machine-readable file. With ~760 hospitals in the state, CMS's 2026 AI-enabled audit ramp means non-compliant files in Texas are more likely than ever to convert a warning letter into a $5,500/day fine.
Texas is a large, high-density state (760+ hospitals) where the federal MRF failure rate compounds across many facilities; state AG has been active on healthcare pricing enforcement.
Federal baseline: 45 CFR Part 180 still applies to every Texas hospital regardless of state rules. Missing either track is an exposure.
| Hospitals in Texas | ~760 |
| State law | TX HB 2253 — Hospital Standard Charges |
| Federal exposure | $5,500/day per violation under 45 CFR 180.50 |
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