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May 29, 2025 – Last week, the Trump administration took steps toward implementing one of its major priorities: improving price transparency. As discussed in a previous Regs & Eggs blog post, President Trump signed an executive order (EO) on price transparency on February 25, 2025, that hinted at changing or even expanding current price transparency requirements for hospitals and health plans. The EO called on the secretary of the US Department of Health and Human Services, working in conjunction with the secretaries of the US Departments of Labor and the Treasury, to take the following actions within 90 days:
Well, 90 days are up. And although rulemaking may be required to fully carry out all the directives included in the EO (which could take a while), the departments issued guidance and requests for information (RFIs) last week that are meant to address some of the issues the administration believes make the current price transparency requirements less effective and meaningful to consumers than they should be. To help me describe the documents released last week, I’m bringing in my colleague Leigh Feldman.
First, the Centers for Medicare & Medicaid Services (CMS) issued guidance and an RFI aimed at clarifying what specific information hospitals must provide under the previously established hospital price transparency requirements. Since January 1, 2021, hospitals have been required to make public:
With respect to the MRF requirement, CMS’s calendar year (CY) 2024 Outpatient Prospective Payment System (OPPS) final rule stated that:
The CMS guidance issued last week reiterates the OPPS reg requirements and states that CMS expects “that, for most contracting scenarios, hospitals’ payer-specific negotiated charges can be expressed as a dollar amount” (emphasis added). The Trump administration has expressed concerns that hospitals too often provide percentages in the MRFs instead of actual dollar amounts and encode 999999999 (nine 9s) as the estimated allowed amount. The Trump administration feels that providing actual dollar amounts will provide a clearer picture to outside stakeholders, including patients, about actual hospital prices are, and it wants hospitals to provide this information, rather than percentages, in most cases.
Now that the guidance is out there, CMS may expect some hospitals to change the information they include in MRFs. However, by also issuing an RFI, CMS signaled that it may make even more changes or issue additional clarifications or guidance around hospital price transparency in the near future. In the RFI, CMS is seeking input on public and stakeholders’ concerns about the accuracy and completeness of MRFs and other considerations for CMS to ensure the accuracy and completeness of the information. Specifically, the RFI includes the following six questions:
Comments on the RFI are due on July 21, 2025. Notably, the CY 2026 OPPS proposed rule will likely be issued before July 21, and the OPPS reg is where CMS has made changes to the hospital price transparency regs in the past. That would mean we might expect the next overhaul of the regs to occur in CY 2027, informed by stakeholders’ comments in response to this RFI.
The departments also issued a short statement and an RFI on the price transparency requirements for health plans. Under current regs, most health plans are already required to disclose, via MRFs on a public website, information regarding in-network provider rates for covered items and services, out-of-network allowed amounts and billed charges for services, and negotiated rates and historical net prices for covered prescription drugs. The departments previously issued technical implementation guidance for the in-network and out-of-network MRFs in the form of schemas but have heard many access-related concerns about “file size, data integrity, and a lack of critical context that limits full transparency.” The departments now state that they plan to issue a revised version of the schemas to address these issues. The “schema version 2.0” will reduce file size by “requiring exclusion of duplicative data [and] reducing unnecessary data fields, and will include updates to better contextualize the data, making it more meaningful to ultimately achieve greater transparency.” The departments are considering future rulemaking to further refine and improve the useability of the MRFs.
In the RFI, the departments note that they never implemented the requirement for health plans to include net prices for covered prescription drugs in MRFs. Because promoting price transparency across the board (including drug pricing) is a high priority, the departments request comments on “the issues related to compliance with, and implementation of, the prescription drug MRF disclosure requirements.” The questions in the RFI focus on the required data elements in the MRFs, including potential additional or alternative data elements, and other general implementation concerns. Responses to the RFI are due in late-June, and they will be used to help inform future rulemaking or guidance on prescription drug price transparency.
All in all, the Trump administration released four separate documents aimed at promoting price transparency last week and indicated that more guidance and regs are to come, so it’s clear that the administration will continue to focus on this issue. Both hospitals and health plans should plan accordingly and be prepared to make changes (if needed) to the methods they are currently using to comply with all the requirements.
Until next week, this is Jeffrey (and Leigh) saying, enjoy reading regs with your eggs.
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