Federal Agency Health Care Price Transparency and Cost Sharing Rules Posted in Federal Register

A late posting in Wednesday’s Federal Register contains the official publication of guidance by several federal agencies with regulatory authority over elements of health care delivery. These include the IRS, the Department of Labor (DOL), and Department of Health and Human Services (HHS). This guidance is being issued in response to an Executive Order by President Donald Trump concerning health care price transparency and patient cost sharing. Members of Congress have also been vocal in requesting that steps be taken to equip citizens to become better informed consumers of health care services.

Cost-Sharing Proposed Regulations
The IRS, DOL, and HHS are jointly issuing proposed regulations under which group health plans and health insurance issuers in the individual and group health insurance markets would be required to disclose certain cost-sharing information.

The stated objective of these proposed regulations is to allow “…a participant, beneficiary, or enrollee (or his or her authorized representative) to obtain an estimate and understanding of the individual’s out-of-pocket expenses and effectively shop for items and services.” This information is to be made available on a website and—if requested—through non-Internet means.

These proposed regulations would also require health insurance plans and issuers to disclose in-network provider negotiated rates, and “historical out-of-network amounts through …machine-readable files posted on an Internet web site, thereby allowing the public to have access to health insurance coverage information that can be used to understand health care pricing and potentially dampen the rise in health care spending.”

Comments will be received for a 60-day period that begins with this publication. The document notes that all comments will be made public, and submitters are, therefore, warned not to include personally-identifiable information. Comments may be submitted electronically, by regular mail, or by express or overnight mail delivery.

Hospital Charges Disclosure Final Regulations
The HHS’s Centers for Medicare and Medicaid Services (CMS) has also issued guidance—these as final regulations—requiring hospitals operating in the United States to “establish, update, and make public a list of their standard charges for the items and services that they provide.” The effective date of these final regulations is January 1, 2021.

The guidance states that this action by the agency is “…necessary to promote price transparency in health care and public access to hospital standard charges” and that the public will thereby “have the information necessary to make more informed decisions about their care.”