The Trump administration is also
moving to require health insurers to post estimates of patients' real prices.
By Allison Bell | November 18, 2019 at
10:30 AM | The original version of this story was
published on ThinkAdvisor
The administration
of President Donald Trump has taken two major steps toward requiring
hospitals and health coverage providers to give patients detailed information
about what care will really cost.
The Centers for
Medicare and Medicaid Services (CMS) — the arm of the U.S. Department of Health
and Human Services that oversees Medicare, Medicaid and the Affordable Care Act
public exchange system — has posted a preview version of a final cost transparency rule for hospitals on the CMS
website.
CMS has also
started the process of trying to require health insurers and group health plans
to reveal what patients’ true out-of-pocket costs will be for specific services
from specific providers.
CMS Administrator
Seema Verma said in a statement that, today, “health care prices are about as
clear as mud to patients.”
“Today’s rules
usher in a new era that upends the status quo to empower patients and put them
first,” Verma said.
What the regulations require
Hospitals already
disclose information about the full list prices they charge for care for
patients who come in without use of a provider network and can afford to pay
the whole bill.
The hospital
cost transparency regulations require hospitals to publish a much more
comprehensive set of charge information, in a single standard data file, on the
Internet, starting in 2021.
The data file must
include “all hospital standard charges (including the gross charges,
payer-specific negotiated charges, the amount the hospital is willing to accept
in cash from a patient, and the minimum and maximum negotiated charges) for all
items and services,” according to CMS.
The data file would
show that a hospital might charge various Blue Cross plans for specific
procedures, and how much it might charge UnitedHealth plans for the same
procedures.
That kind of file
will be too big for most consumers to use, but hospitals will also have to
provide “payer-specific negotiated charges” for 300 “common shoppable services
in a manner that is consumer-friendly.”
The shoppable
services tool might have to show, for example, how much a hospital would charge
an enrollee in a specific Aetna network for an MRI, or how much it would charge
an enrollee in a specific Cigna network for a visit to an eye doctor.
CMS has sent the
final regulations to the Office of the Federal Register for publication. The
preview version is not yet available on the Office of the Federal Register
website, and an anticipated publication date is not yet available. The office
keeps many major CMS regulatory documents in preview mode for several days
before officially publishing them.
In some cases,
parties affected by regulations challenge the regulations in court and get
courts to block implementation.
In other cases,
parties may be able to get Congress to pass legislation blocking
implementation.
What the Trump administration wants providers
to post
CMS has also joined
with the Internal Revenue Service, which is an arm of the U.S. Treasury
Department, and the Employee Benefits Security Administration, which is an arm
of the U.S. Labor Department, to draft a proposal for cost transparency
regulations for health insurers and group health plans.
Those proposed
regulations will require coverage providers to give consumers real-time,
personalized information about how much they are likely to have to pay
out-of-pocket for all covered health care products and services, through an
online tool.
Many health
insurers, such as Aetna, already provide cost estimator tools through websites
or apps. It was not immediately clear whether the existing tools would meet the
requirements in the proposed regulations.
The proposed
regulations would also require coverage providers to post their negotiated
rates for in-network providers on the web, and post the allowed amounts they
pay for care from out-of-network providers, officials said.
Comments on the
proposed regulations will be due 60 days after the official Federal Register
publication date.
Like the final
hospital cost transparency final regulations, the health plan proposed
regulations packet is not yet available on the Office of the Federal Register
website.
Health insurers’ reaction
Some antitrust
experts have argued that, even though requiring more disclosure of health care
price information might seem helpful for patients, increased disclosure could
backfire, by giving hospitals, physicians and other health care providers
information they can use to push up prices.
America’s Health
Insurance Plans (AHIP) has traditionally resisted many federal and state cost
transparency measures, on the grounds that they would disrupt plan-provider
negotiations and reduce plans’ bargaining clout.
AHIP
President Matt Eyles said in a statement that AHIP has concerns about the
hospital cost transparency regulations and the proposed health plan cost
transparency regulations.
“Every American
should be able to get personalized health care cost and quality information
before they seek care,” Eyles said. “Actionable and personalized information
will help patients make informed decisions that are best for their needs.”
But transparency
“should aid and support patient decision-making, should not undermine
competitive negotiations that lower patients’ health care costs,” Eyles said.
“We will continue to engage collaboratively with the administration and other
health care stakeholders on how we can best work together to achieve lower
prices and costs while protecting health care quality, choice, value, and
privacy for the hardworking Americans we serve.”
Resources
A copy of a press
release describing the final and proposed regulations, and links to
preview versions of the final regulation packet and the proposed regulation
packet, is available here.
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