HHS Releases Price Transparency Rules

On November 15, the U.S. Department of Health and Human Services (HHS) announced the release of two healthcare price transparency rules. One is a final rule requiring hospitals to make available online all standard charges for items and services, including discounted rates negotiated with third-party payers. The second is a proposed rule that would require most employer-based group health plans and health insurers to disclose price and cost-sharing information to participants and beneficiaries upfront.

The hospital price transparency rule, which bears the unwieldy name “Calendar Year (CY) 2020 Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) Price Transparency Requirements for Hospitals to Make Standard Charges Public Final Rule,” was first proposed several months ago. At that time, the American Hospital Association and other organizations objected strongly to the requirement, but HHS largely ignored the objections. Hospitals must now comply with the new rule by January 1, 2021 or face possible financial penalties.

The proposed “Transparency in Coverage” rule applicable to health plans would require them to give consumers “real-time, out-of-pocket estimates,” including cost-sharing liability for all covered items and services, and the plans’ negotiated rates for in-network providers and allowed amounts paid for out-of-network care. All of this information would need to be made available online, as well as in paper form if requested by the consumer. Public comments on the proposed rule will be accepted until 60 days after it is published in the Federal Register.