Hospital Price Transparency Updated Rules

This past July 13th the Centers for Medicare & Medicaid Service (CMS) proposed changes to the hospital price transparency regulations. The changes aim to further advance CMS’ commitment to increasing price transparency while enforcing compliance. The biggest change in the proposal is the increasing and enforcing of price transparency in hospitals. As of January 1st, 2021, any institution licensed by a state as a hospital is subject to the requirements of the Transparency in Coverage rule. Failure to comply, as agreed upon previously, will result in financial penalties. CMS decided to increase the maximum potential for failed compliance. This increase would go from a little over $100,000 per hospital to over $2 million for larger hospitals beginning in 2022. In this context, “larger” hospitals are classified as having at least 500 or more beds.

In this new proposal CMS remarks on the success of their current strategy. They also admits to additional work needing to be done. One piece of this additional work is the announcement of enforcement process changes. To increase compliance CMS is requiring a corrective action plan, completion deadlines, monetary penalties for failure to submit a requested corrective plan on time. They will also eliminate warning notices for hospitals that have not made any changes to satisfy the requirements.

Additionally CMS is requiring a comprehensive machine-readable file for prices and are requiring hospitals publicize standard charges for hundreds of shoppable services in a consumer-friendly format. The other alternative is to offer a price estimator tool that can show personalized out-of-pocket costs. Essentially making it so that whatever service you may need you will be able to see the projected cost at any hospital. This again is all in conjunction with the Transparency in Coverage regulations.

When these proposed changes are finalized, they will go into effect January 1st, 2024. At the end of the day the goal stays the same: enhance availability and accessibility of hospital pricing information for patients so they can make informed financial decisions about their health. The CMS has posted a fact sheet carefully detailing each change:

For more information on price transparency and health in general please visit our blog.

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