CMS finalizes hospital price transparency rule: 6 things to know

CMS issued a final rule Nov. 15 that requires hospitals to disclose the rates they negotiate with insurers beginning in 2021. The Trump administration also released a proposed rule that would require health plans to share price and cost-sharing information with members up front.

Hospital price transparency final rule

1. Comprehensive "standard charges" file. The final rule requires hospitals to post their "standard charges" online in a machine-readable file. Under the definition adopted by CMS, standard charges include the following: 1) gross charges; 2) discounted cash prices; 3) payer-specific negotiated charges; 4) de-identified minimum negotiated charges; and 5) de-identified maximum negotiated charges.

Hospitals will be required to disclose the standard charges for all items and services, including supplies, facility fees and professional charges for employed physicians and other practitioners. 

2. Publicize 300 "shoppable services." The final rule requires hospitals to post payer-specific negotiated rates online in a searchable and consumer-friendly manner for 300 services that patients are likely to shop around for. Seventy of the services are stipulated in the rule. Hospitals can choose the other 230 services they post online.

3. Penalties. Hospitals that fail to publish the negotiated rates online could be fined up to $300 per day.

Access the final rule here.

Health plan transparency proposal

4. Negotiated rates. The proposal would require health insurance companies and group health plans that cover employees to disclose on a public website their negotiated rates for in-network providers and allowed amounts paid for out-of-network providers. This requirement would promote competition in the healthcare industry, drive innovation and support price-conscious decision-making, CMS said in a fact sheet on the proposed rule.

5. Transparency tool. Under the proposal, health insurers would be required to offer a transparency tool to provide members with personalized out-of-pocket cost information for all covered services in advance. "This requirement would empower consumers to shop and compare costs between specific providers before receiving care," CMS said.

6. Comments. There will be a 60-day public comment period on the proposed rule.

Access the proposed rule here.

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