Final Price Transparency Rule Announced; New Proposed Rule for Health Plans

The Centers for Medicare and Medicaid Services was directed to announce two rules that take “historic steps to increase price transparency to empower patients and increase competition among all hospitals, group health plans and health insurance issuers in the individual and group markets,” according to a U.S. Department of Health and Human Services press release.

Compliance would be required by January 1, 2021 according to the latest news release. The final price transparency rule that published has been expected this year and an additional rule has been proposed alongside the that would impact health-insurers and employer-based coverage.

New Proposed Rule for Health Plans

The proposed rule for health-insurers, Transparency in Coverage, would require two caveats for health plans, according to the release:

  • Give consumers real-time, personalized access to cost-sharing information, including an estimate of their cost-sharing liability for all covered healthcare items and services, through an online tool that most group health plans and health insurance issuers would be required to make available to all of their members, and in paper form, at the consumer’s request. This requirement would empower consumers to shop and compare costs between specific providers before receiving care.
  • Disclose on a public website their negotiated rates for in-network providers and allowed amounts paid for out-of-network providers. Making this information available to the public is intended to drive innovation, support informed, price-conscious decision-making, and promote competition in the healthcare industry. Making this information public directly helps the consumer, but, more importantly, creates new opportunities for researchers, employers and other developers to build new tools to help consumers.

Hospital administrators want to continue the price transparency efforts you’ve already started not only for compliance but ultimately, the competitive advantage it will give your organization.

Price Transparency Toolkit

Consider the price transparency toolkit Windham Brannon created for your use as you continue to move forward:


Email Windham Brannon’s Healthcare Advisor Valerie Barckhoff to ensure you’re on the right path forward to stay ahead of the latest regulations and deadlines.

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