Anticipated Federal Hospital and Payor Transparency Rules

For more information about this blog post, please contact Khaled J. KleleLatoya Caprice Dawkins, or Ryan M. Magee.

As we previously reported, on November 15, 2019, CMS issued a final rule and comment period that revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for Calendar Year 2020. In that final rule, CMS made clear that it intends to continue with its policy to require hospitals to publicly disclose "standard charges," including payer-specific negotiated rates.  CMS, however, did not actually publish the final rule in the registry and, instead, CMS stated it “received over 1,400 comments on our proposed requirements for hospitals to make public their standard charges. We intend to summarize and respond to public comments on the proposed policies in a forthcoming final rule.”   The fact sheet on the anticipated rule, however, explains hospitals will have until 2021 to comply with the new price disclosure requirements.  The anticipated rule requires hospitals to post publicly in a machine-readable file "standard charges," which is defined as gross charges, payer-specific negotiated charges, discounted cash prices, and de-identified minimum and maximum negotiated charges, for all items and services provided by the hospital.  Hospitals must also make public charges for at least 300 common "shoppable" services in a consumer-friendly and searchable format with annual updates.  

In the same view, HHS and the Departments of Labor and Treasury anticipate releasing a joint proposed rule entitled “Transparency in Coverage” that would require most group health plans, including self-insured plans, and health insurance issuers to disclose price and cost-sharing information to consumers.  According to the fact sheet, plans and issuers would provide consumers with real-time, personalized access to cost-sharing information through an online tool available to their members and in paper form upon request.

Providers and insurers have already indicated that they will challenge these rules.