While the Transparency in Coverage final rule is set to take effect Jan. 1, CMS will delay enforcement of key parts of the rule until July 1 to give health plans more time to comply.
The rule requires insurers and health plans to disclose in-network provider rates for covered items and services, out-of-network allowed amounts and billed charges for all covered items and services, and negotiated rates and historical net prices for covered prescription drugs. These are expected to be in three separate machine-readable files.
In deciding to delay enforcement of the rule, CMS said it understood the “considerable time and effort required to make the machine-readable files available in the form and manner required in the [Transparency in Coverage rule].”
“On July 1, 2022, the departments intend to begin enforcing the requirement that plans and issuers publicly disclose information related to in-network rates and out-of-network allowed amounts and billed charges for plan years,” CMS said.
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