CMS hospital price transparency rule now in effect

Posted on: 1/8/21

The Centers for Medicare & Medicaid Services (CMS) hospital price transparency rule became effective Jan. 1 and requires hospitals operating in the U.S. to establish, update and make public a list of their standard charges for the items and services that they provide. CMS believes these actions are necessary to promote price transparency in health care and public access to hospital standard charges. 

In the final rule, CMS establishes the following policies:
• Definitions of “hospital,” “standard charges,” and “items and services.”
• Requirements for making public a machine-readable file online that includes all standard charges (including gross charges, discounted cash prices, payer-specific negotiated rates [but defined as charges in the final rule], and de-identified minimum and maximum negotiated rates) for all hospital items and services.
• Requirements for making public discounted cash prices, payer-specific negotiated rates, and de-identified minimum and maximum negotiated rates for at least 300 “shoppable” services (70 CMS-specified and 230 hospital-selected) that are displayed and packaged in a consumer-friendly manner.
• Monitoring for hospital noncompliance and actions to address hospital noncompliance – including issuing a warning notice, requesting a corrective action plan, and imposing civil monetary penalties – and a process for hospitals to appeal these penalties.

More information and CMS resources can be found here. (Mitzi McCullock)