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 to Post
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.