Today, as directed by an Executive Order from President Trump, the Department of Health and Human Services announced that the Centers for Medicare and Medicaid Services (CMS) has issued two rules to increase healthcare price transparency, at both hospital and payer levels.
The rule changes require that pricing information be made publicly available in an effort to “increase price transparency to empower patients and increase competition among all hospitals, group health plans and health insurance issuers in the individual and group markets,” as it was stated by HHS in a press release this morning.
The first—”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”—is a rule that requires hospitals to make all standard charges, including gross charges, payer-specific negotiated rates, the amount a hospital is willing to accept in cash from a patient, and the minimum and maximum negotiated charges, public on the internet in a machine-readable file.
The second rule change, known as the “Transparency in Coverage” rule, which was proposed jointly by the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury, would require most health insurers, including those issuing employer-based group health plans, to disclose price and cost-sharing information to participants, beneficiaries, and enrollees up front.
“President Trump has promised American patients ‘A+’ healthcare transparency, but right now our system probably deserves an F on transparency. President Trump is going to change that, with what will be revolutionary changes for our healthcare system,” said HHS Secretary Alex Azar in this morning’s press release. “Today’s transparency announcement may be a more significant change to American healthcare markets than any other single thing we’ve done, by shining light on the costs of our shadowy system and finally putting the American patient in control.”
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