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CMS Issues Price Transparency Rules in Response to Executive Order

The Centers for Medicare & Medicaid Services (CMS) released a final rule and a proposed rule November 15 regarding health care price information in response to the June 2019 Executive Order, Improving Price and Quality Transparency in American Healthcare to Put Patients First.

The Hospital Price Transparency Requirements final rule expands the Public Health Service Act to require hospitals to publicly disclose price information, including gross charges, discounted cash prices, payor-specific negotiated charges, and de-identified minimum and maximum negotiated charges, for all items and services online in a single digital file. Hospitals also must make public price information for at least 300 “shoppable services” (that is, services that patients can schedule in advance) in a consumer-friendly manner, such as through an Internet-based price estimator. These requirements take effect January 1, 2021.

The Transparency in Coverage proposed rule, which CMS issued in conjunction with the Department of Labor and the Department of the Treasury, includes policies that would, if finalized, require payors to disclose on a public website their negotiated rates for in-network clinicians and allowed amounts paid for out-of-network clinicians. Payors offering coverage in the individual and group markets would be required to make available to enrollees personalized out-of-pocket cost information for all covered health care items and services through an online self-service tool. Payors also would be required to publicly disclose in-network negotiated rates with their network clinicians and historical payments of allowed amounts to out-of-network clinicians through standardized, regularly updated machine-readable files.

Fact sheets for the Hospital Price Transparency Requirements final rule and Transparency in Coverage proposed rule are available on the CMS website. Contact with questions.

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