Rules issued on disclosure of hospital and health plan negotiated rates
The Administration today released a final rule requiring hospitals to disclose payer-specific negotiated rates, along with a proposed rule that would impose new requirements on private insurers in the individual and group markets to publicly disclose negotiated rates and out-of-network allowed amounts, and give their enrollees real-time, personalized access to cost-sharing information.
Specifically, the Centers for Medicare & Medicaid Services’ final rule will require hospitals to post a list of five types of standard charges — now defined as gross charges, payer-specific negotiated rates, the de-identified minimum and maximum negotiated rates and discounted cash price — for all items and services in a machine-readable format on their websites. In addition to the machine-readable file, CMS will require hospitals to post the negotiated rates, minimum and maximum negotiated rates, and discounted cash price for 300 “shoppable” services in a consumer-friendly way that is both easily understood and searchable. CMS also finalized a process for monitoring and enforcing compliance, including civil monetary penalties. The effective date of the final rule is Jan. 1, 2021.
In a joint statement with other national hospital groups, AHA said the final rule is a “setback in efforts to provide patients with the most relevant information they need to make informed decisions about their care. Instead of helping patients know their out-of-pocket costs, this rule will introduce widespread confusion, accelerate anticompetitive behavior among health insurers, and stymie innovations in value-based care delivery. America’s hospitals and health systems have repeatedly urged CMS to work with hospitals, doctors, insurers, patients, and other stakeholders to identify solutions to provide patients with the information they need to make informed health care decisions and know what their expected out-of-pocket costs will be. We continue to stand ready to work with CMS to achieve this goal.
“Because the final rule does not achieve the goal of providing patients with out-of-pocket cost information, and instead threatens to confuse patients, our four organizations will soon join with member hospitals to file a legal challenge to the rule on grounds including that it exceeds the Administration’s authority.”