CMS today issued its Price Transparency Requirements for Hospitals Final Rule, which will go into effect on January 1, 2021. (CMS had initially proposed that it go into effect January 1, 2020, but agreed that that deadline was too “challenging”). Hospitals will be required to post on a public website, among other things, the “payer-specific negotiated charges” for each payer and plan. These negotiated rates have typically been subject to lock and key treatment through confidentiality agreements. Noncompliance with the rules may result in corrective action plans (CAPs), civil monetary penalties (CMPs) of $300 per day (indexed to an inflation factor), and a public notice of the CMP on a CMS website. Under the rules, CMS can issue “subsequent” CMPs for continued noncompliance. A link to the Final Rule is here: https://www.hhs.gov/sites/default/files/cms-1717-f2.pdf.
The Trump Administration has also issued a proposed “Transparency in Coverage” rule that would require plans to give consumers access to a tool providing an estimate of their cost-sharing liability for all covered healthcare items and services. It would also require plans to list on a website their negotiated rates for in-network providers and the allowed amounts paid for out-of-network providers. A link to the Proposed Rule is here: https://www.hhs.gov/sites/default/files/cms-9915-p.pdf.
We will continue to analyze and monitor these rules. Stay tuned.