On October 29, CMS released the final rule on price transparency. The Rule requires insurers to make public their negotiated rates with hospitals and healthcare providers.
- The final rule requires health insurers to offer an online self-service tool that gives consumers the ability to see the negotiated rate between their doctor and their plan or insurer. In theory, consumers will see the most accurate out-of-pocket cost estimate available based upon their health plan for coverage of procedures, drugs, durable medical equipment, and any other item or service needed. This information must also be provided on paper if requested.
- Beginning on or after January 1, 2023, issuers are required to provide estimates for the 500 items and services identified by CMS. For plan years beginning on or after January 1, 2024, issuers will be required to disclose pricing information with respect to all items and services.
- The final rule also requires plans and issuers to disclose in-network provider negotiated rates, historical out-of-network allowed amounts, and drug pricing information through three machine-readable files posted on an internet website beginning on or after January 1, 2022.
- The Department of Health and Human Services (HHS) also finalized amendments to its medical loss ratio (MLR) program rules to allow issuers offering group or individual health insurance coverage to receive credit in their MLR calculations for savings they share with enrollees that result from the enrollees shopping for, and receiving care from, lower-cost, higher-value providers.
- By requiring standardized formatting and regular updates Advis expects private sector researchers and developers to create additional consumer friendly tools to further incentivize competition.
For more information on this rule or to learn how Advis can assist your organization, please contact us online or by calling 708-478-7030.
Published: October 29, 2020