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CMS Releases Hospital Price Transparency Final Rule

November 15, 2019

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PRESS CONTACTS
Mary Mullaney, Director, Hospital Payment Policies

The Centers for Medicare and Medicaid Services (CMS) Nov. 15 released the final rule requiring hospitals to publicly post hospital standard charges beginning January 1, 2021.  These requirements were proposed in the calendar year (CY) 2020 Outpatient Prospective Payment System (OPPS) proposed rule [see Washington Highlights, Aug. 2]. 

The AAMC, along with other national hospital groups, issued a statement expressing concern with the rule. The groups stated that the “rule mandating the public disclosure of privately negotiated rates between commercial health insurance companies and hospitals is a setback in efforts to provide patients with the most relevant information they need to make informed decisions about their care.” The statement also laments that 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.”

Under the rule, hospitals will be required to make public all hospital standard charges – including gross charges, payer-specific negotiated charges, the cash amount the hospital is willing to accept from a patient, and the minimum and maximum negotiated charges – for all items and services provided by the hospital.  This information must be posted online in a single, machine-readable format that includes common billing or accounting codes used by hospitals.  Additionally, a description of each item or service must be included to allow consumers to compare standard charges among hospitals.

Hospitals will also be required to post, and update annually, pricing information for 300 common shoppable services in a consumer-friendly manner and in a prominent online location.  Pricing information includes 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 the shoppable services.   Descriptions of the items and services must be in “plain language” and must be displayed and grouped with charges for any ancillary services the hospital customarily provides with the shoppable service.

The final rule provides CMS with new enforcement tools to ensure hospital compliance, including corrective action plans and the ability to impose civil monetary penalties for $300 per day. 

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