New Rules Aim for Transparency

November 6, 2023

Improving Delivery

New Rules Aim for Hospital, Insurer Transparency

THE TRUMP administration in November 2019 announced two rules that would require more transparency in hospital pricing and health insurance out-of-pocket costs. A final rule will require hospitals to publish their standard fees both on-demand and online starting Jan. 1, 2021, as well as the rates they negotiate with insurers. A proposed rule would require health insurers to provide enrollees instant, online access to an estimate of their out-of-pocket costs for various services.The Trump administration has a stated mission to bring more transparency into the health care and insurance industry. That’s in response to increasing consumer stories of receiving unaffordable surprise bills from providers, particularly if they went to a non-network physician or hospital. Both rules could benefit health plan enrollees by giving them more information on hospital services, particularly if they are in high-deductible plans and can shop around for a future procedure.

Hospital pricing transparency

The new final rules will require hospitals to publish in a“consumer-friendly manner” online their standard charges price list of at least 300 “shoppable services,” meaning services that can be scheduled in advance, such as a CAT scan or hip replacement surgery. The list must include 70 services or procedures that are preselected by the Centers for Medicare and Medicaid Services.Hospitals will have to disclose what they’d be willing to accept if the patient pays cash. Under the rule, hospitals will have to disclose the rates they negotiate with third party payers. The new rules face some uncertainty. The American Hospital Association and the Federation of American Hospitals, and other trade groups, announced that they would sue the government, alleging that the rules exceed the bounds of the CMS’s authority.

Out-of-pocket transparency

The proposed rule would require insurers to provide health plan enrollees with instant online access to estimates of their out-of-pocket costs. The regulations would require health insurers to create online tools their policyholders can use to get a real-time personalized estimate of their out-of-pocket costs for all covered health care services and products.

They would also be required to disclose on a website negotiated rates for their in-network providers, as well as the maximum amounts they would pay to an out-of-network doctor or hospital. The proposed regs would also let insurers share cost savings with their enrollees if the individuals shop around for services that cost less than at other providers.

These are for now proposed regulations. They have to go through the standard rule-making procedures including soliciting public comments before eventually issuing the final rules, probably this year. v