Brian Lee, Alston & Bird LLP
Standard Hospital Charges
A Trump-era final rule mandating enhanced price transparency requirements for hospitals took effect on January 1, 2021. The requirements were promulgated based on an Affordable Care Act requirement that hospitals make public their “standard charges” for items and services provided. While this requirement previously was met through a hospital making its chargemaster available, hospitals must now disclose more granular and more sensitive information.
Consumer-Friendly Information
Hospitals are now required to publish payer-specific negotiated charges, de-identified minimum and maximum negotiated charges, and discounted cash prices in a machine-readable format. Hospitals are further required to make available a “consumer-friendly” file of at least 300 “shoppable services” (or services that a patient can schedule in advance). Hospitals can meet the “shoppable services” requirement if they maintain an internet-based price estimator tool that provides estimates of a patient’s financial obligation for the identified shoppable services.
CMS Audits Begin
On December 29, 2020, the DC Circuit Court of Appeals unanimously rejected an industry-backed challenge, ruling in favor of HHS and signifying that the rule was in good standing when its effective date arrived. Hospitals are now subject to monitoring and penalties for noncompliance with these requirements, including a maximum daily civil monetary penalty of $300. On December 18, 2020, the Centers for Medicare & Medicaid Services (CMS) indicated that it plans to audit a sample of hospitals for compliance starting in January, in addition to investigating complaints and reviewing analyses of non-compliance. Reports indicate that CMS has begun this auditing. It remains to be seen whether the Biden Administration will reconsider the auditing and enforcement approach or take a less aggressive monitoring posture.
For more details, visit cms.gov.
