HHS Completes Historic Price Transparency Initiative

Last week, U.S. Department of Health and Human Services (HHS)/Centers for Medicare & Medicaid Services (CMS) along with the Departments of Labor and the Department of the Treasury issued a final rule on price transparency, helping to ensure every American knows how much their healthcare will cost in advance and allowing them to make fully informed and value-conscious decisions. The rule requires most private health plans, including group health plans and individual health insurance market plans to disclose pricing and cost-sharing information and fulfills a key element of President Trump’s Executive Order on price and quality transparency.Under this final rule, about 200 million Americans will gain access to real-time price information, enabling them to know how much their healthcare will cost them before going in for treatment. The rule requires group health plans and health insurance issuers in the individual and group markets to not only provide easy-to-understand personalized information on enrollee cost-sharing for healthcare services, but they must also publicly disclose the rates they actually pay healthcare providers for specific services. This will allow for unprecedented price transparency that will benefit employers, providers, and patients to help drive down healthcare costs.

Starting on January 1, 2023 (plans beginning on or after that date), the rule will require health plans to offer an online shopping tool that will allow consumers to see the negotiated rate between their provider and their plan, as well as a personalized estimate of their out-of-pocket cost for 500 of the most shoppable items and services. Then starting on January 1, 2024, these shopping tools will be required to show the costs for the remaining procedures, drugs, durable medical equipment and any other item or service they may need.

In addition, by January 1, 2022, this rule will require plans to make publicly available standardized and regularly updated data files, which would open new opportunities for research and innovation to drive improvements within the healthcare market. With this data, entrepreneurs, researchers, and developers will be able to create private sector solutions for patients to help them make decisions about their care. Further, people who are uninsured or shopping for health insurance will be able to understand how health care items and services are priced under health insurance coverage. Technology companies can create additional price comparison tools and portals that will further incentivize competition, as well as allow for unprecedented research studies and data analysis into how healthcare prices are set. With this information available to the public, there can finally be pressure on those that price gouge consumers when they are at their most vulnerable.

Please reach out to your AssuredPartners’ Sales Executives or Account Manager to discuss how your team at AP will make sure you, your carriers, and vendor-partners will be positioned to reach each of these Transparency milestones, together in 2022, 2023, and 2024. Thank you.

Links:

• CMS/HHS fact sheet
• Final Rule (556 pages)
• Other CMS transparency requirements