CMS Finalizes Hospital Transparency Requirements and Proposes Similar Policies for Certain Health Plans

In the latest response to the President’s Executive Order on Improving Price and Quality Transparency in American Healthcare, the Department of Health and Human Services released two rules related to requiring increased price transparency for hospitals and health plans:

  • Hospital Transparency Final Rule: CY 2020 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Price Transparency Requirements for Hospitals to Make Standard Charges Public Final Rule (CMS-1717-F2)
  • Health Plan Transparency Proposed Rule: Transparency in Coverage Proposed Rule (CMS-9915-P)

The hospital transparency final rule will require hospitals to make public total charges for services, discounted cash prices, third-party negotiated rates, and the minimum and maximum negotiated charges. Hospitals will be required to provide, and update annually, a database for all services provided and a readable, consumer-friendly list of 300 “shoppable” services for patient use. These policies go into effect on January 1, 2021.

The health plan transparency proposed rule would require most group health plans, including self-insured plans and health insurance issuers, to disclose the price and cost-sharing information to participants, beneficiaries and enrollees. The rule proposes to require insurers to provide personal out-of-pocket cost information for all services to beneficiaries in an online tool. Additionally, the rule would require insurers to make public the in-network negotiated rates and historic payments to out-of-network providers.

It estimated that there are approximately 6,002 hospitals operating within the United States that would become subject to the new disclosure requirements.

CMS Conference Call on Hospital Final Rule

CMS is hosting a conference call on the hospital price transparency final rule call on Tuesday, December 3 from 1:30 pm – 3:00 pm ET. Registration information is available here.

Additional analysis on the transparency rules by McDermott, Will, and Emery can be found here.



For more information visit the McDermottPlus Payment Innovation Resource Center or contact Jessica Roth at 202-2014-1452/ or Eric Zimmerman at 202-204-1457/