In the FY 2015 IPPS/LTCH proposed rule (79 FR 28169) and final rule (79 FR 50146), CMS discussed and then implemented Section 2718(e) of the Public Health Service Act, which was enacted as part of the Affordable Care Act. The rule aimed to improve the transparency of hospital charges by requiring hospitals to either post standard charges online or to comply with patient requests for such information.
In April 2018, in response to consumer concern and surprise over out-of-network physician services at in-network hospitals, as well as the price of emergency department services, CMS further requested comment on a proposed rule that would require more transparency in hospital pricing. The new rule was officially finalized on August 2, 2018 and requires hospitals to make public a list of their standard charges via the Internet in a machine-readable format, which hospitals must update at least annually. CMS received positive feedback in April from providers and hospitals, and CMS commented in the final rule that this change aligns with American Hospital Association State Transparency Survey data indicating that 35 States already require hospitals to release pricing information for certain charges and that 7 States rely on voluntary disclosure of standard pricing data.
This final rule is a result of a push by the Trump Administration hoping to lower medical costs by encouraging price transparency among medical providers and improve public accessibility to information. According to CMS Administrator Seema Verma, the Trump administration’s work in this area is just beginning. CMS and the Trump Administration is further encouraging individual states to tackle price transparency via legislation which would allow prospective patients to shop around for the best pricing for future medical services.
This final rule is set to be published on CMS’s website on August 17th, and will take effect on January 1, 2019. In the interim, the CMS final rule can be found online here.
Although price transparency may seem simple for healthcare providers, price transparency is more complex than it appears. The Health Law Partners often advises and counsels clients on compliance with price transparency regulations and related issues. For more information on this topic, please contact Clinton Mikel, Esq. at (248) 996-8510 or by email at firstname.lastname@example.org.