WASHINGTON,Dec. 19, 2023 – The Biden-Harris Administration proposed significant updates Tuesday to healthcare price clarity rules, aiming to give Americans clearer, more accurate, and actionable cost data. The proposal, shared by the Centers for Medicare & medicaid Services (CMS) in partnership wiht the Departments of Labor and the Treasury, builds upon regulations initially established during the Trump administration.
Making Healthcare Costs Less of a Mystery
The new rules seek to simplify healthcare pricing data, empowering patients to make informed decisions about their care.
- The proposed changes focus on simplifying how health plans and insurers organize pricing data.
- Updates include excluding unlikely services from rate files and improving tracking with change logs.
- Price comparison tools will require more detailed and consistent cost-sharing information.
- The No Surprises Act protections will be reflected in updated disclosures.
“Americans have a right to know what healthcare costs before they pay for it,” said Department of Health and human Services (HHS) Secretary Robert F. Kennedy Jr.in a dec. 19 news release. “This proposal delivers real transparency by turning hidden pricing into clear, usable information – so families can make informed decisions and hold the system accountable.”
The 2020 Transparency in Coverage rules were the first major effort to require health insurance companies to publicly release detailed healthcare pricing information. However, the data proved difficult for employers, the public, and researchers to navigate. These new updates aim to address those challenges by making consumer-facing cost tools more accessible and reducing unneeded information.
What exactly are the proposed improvements? The suggested changes, primarily for health plans and insurers, include excluding services that are rarely needed from in-network rate files, adding change-log and utilization files to improve tracking, reorganizing files by provider network to reduce redundancy, and reducing the frequency of reporting from monthly to quarterly. The proposal also calls for expanding out-of-network pricing data with longer reporting periods and lower claims thresholds.
Under the proposed rule, price comparison tools will be strengthened, requiring issuers to provide detailed, consistent cost-sharing information through phone, print, and online channels.
changes to prescription drug disclosure requirements are not included in this proposal and will be addressed separately by the department.Stakeholders can submit feedback on the proposed rule during a 60-day comment period, which ends Feb. 21.
“Every person deserves to know what their health care will cost without needing a team of analysts to decode it,” said CMS Administrator Mehmet Oz,
Explanation of Changes & Answers to Questions:
* Why: The Biden-Harris Administration proposed these updates to simplify healthcare price transparency rules,making cost information clearer and more accessible to americans. The original 2020 rules were difficult to navigate.
* Who: The proposal was shared by the Centers for Medicare & Medicaid Services (CMS) in partnership with the Departments of Labor and the treasury. Key figures quoted include HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Mehmet oz. The rules primarily affect health plans and insurers.
* What: The updates include excluding rarely needed services from rate files, improving tracking with change logs, reorganizing files, reducing reporting frequency, expanding out-of-network data, and strengthening price comparison tools.
* How did it end? The proposal is currently open for a 60-day comment period, ending February 21, 2024. Stakeholders can submit feedback,
