FOR IMMEDIATE RELEASE
October 29, 2020
Contact: HHS
Press Office
202-690-6343
media@hhs.gov
Trump
Administration Finalizes Rule Requiring Health Insurers to Disclose Price and
Cost-Sharing Information
Today, the Department of Health and Human Services, the Department
of Labor, and the Department of the Treasury issued a final rule on price
transparency, helping to ensure Americans know how much care will cost in
advance and allowing them to make fully informed and value-conscious decisions.
The rule requires that almost all health insurance companies and self-insured
plans disclose pricing and cost-sharing information.
Under this final rule, more than 200 million Americans with
private-sector insurance (both individual-market and employer-based) will have
access to a list of real-time price information, including cost-sharing,
enabling them to know how much care will cost them before going in for
treatment.
“President Trump’s actions to require full transparency on prices
throughout our healthcare system may be the single most pro-patient, pro-consumer
reform American healthcare has ever seen,” said HHS Secretary Alex Azar. “We
want every American to be able to work with their doctor to decide on the
healthcare that makes sense for them, and those conversations can’t take place
in a shadowy system where prices are hidden. With more than 70 percent of the
most costly healthcare services being shoppable, Americans will have vastly
more control over their care, delivering on the President’s vision of better
care, lower costs, and more choice.”
“President Trump is solving longstanding problems in our
healthcare system; hidden healthcare prices have produced a dysfunctional
system that serves special interests but leaves patients out in the cold,” said
Centers for Medicare & Medicaid Services Administrator Seema Verma. “Price
transparency puts patients in control and forces competition on the basis of
cost and quality which can rein in the high cost of care. CMS’ action
represents perhaps the most consequential healthcare reform in the last several
decades.”
“This final rule opens the way to greater openness and
transparency in our healthcare system,” said U.S. Secretary of Labor
Eugene Scalia. “American workers in employer-sponsored health plans will
now have access to real-time, personalized cost-sharing information that
empowers them to shop and compare costs between specific providers before
receiving care. Today’s rule is another example of the Trump
Administration improving healthcare access and options for American workers.”
The rule requires that most health plans and health insurers not
only provide easy-to-understand personalized information on enrollee
cost-sharing for healthcare services, but must also publicly disclose the rates
they actually pay healthcare providers for specific services.
Through a shopping tool available through their plan or insurance
company, consumers will be able to see the negotiated rate between their doctor
and their plan or insurer, as well as the most accurate out-of-pocket cost
estimate possible based on their health plan for procedures, drugs,
durable medical equipment, and any other item or service they may need.
Consumers will also have access to accurate price and plan
information that allows them to shop and compare costs between individual
doctors before receiving care, so they can choose a healthcare provider that
offers the most value and best suits their medical needs.
The rule also allows insurers that pass on savings to consumers in
plans that encourage use of services from lower-cost, higher-value providers,
by allowing insurers to take credit for such “shared savings” payments in their
medical loss ratio (MLR) calculations beginning with the 2020 MLR reporting
year.
The Departments are also requiring plans and issuers to make
publicly available a standardized, regularly updated data file, which would
offer for the first time an open opportunity for research, innovation and
comparison within the healthcare market. With this data, innovators,
researchers, and developers will be able to create private sector solutions for
patients to help them make decisions about their care and will allow consumers
to not only see what something costs from their current plan but also what it
could cost with a competitor’s health plan or for people who are uninsured.
Technology companies can create additional price comparison tools that will
further incentivize competition. There will also be the potential for
unprecedented research and analysis into how healthcare prices are set,
providing new transparency into a once-shadowy market.
The requirement for the publicly available data files will take
effect for plan or policy years beginning on or after January 1, 2022. Plans
and issuers must make cost-sharing information available for 500 specified
items and services for plan or policy years beginning on or after January 1,
2023, and must make cost-sharing information available for all items and
services for plan or policy years beginning on or after January 1, 2024.
Today’s announcement builds on HHS’s efforts over the past three
years to promote price and quality transparency, which have also included
requiring hospitals to provide access to negotiated charges; requiring
real-time pharmacy-benefit tools in all Medicare Part D plans no later than
January 1, 2021; and requiring that many payers provide consumers access to
their electronic health record through interoperability rules issued by CMS and
the Office of the National Coordinator for Health IT.
Read more on CMS’s transparency work: www.cms.gov/newsroom/press-releases/cms-completes-historic-price-transparency-initiative
Read a CMS fact sheet on the final rule: www.cms.gov/newsroom/fact-sheets/transparency-coverage-final-rule-fact-sheet-cms-9915-f
Read the rule: https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/CMS-Transparency-in-Coverage-9915F.pdf -
PDF
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Last revised: October 29, 2020
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