HHS Issues Final Rule for Pricing Transparency

The US Department of Health and Human Services (HHS), in collaboration with the Department of Labor and the Department of the Treasury, announced the final rule requiring health insurers to disclose price and cost-sharing information.

“Under this final rule, more than 200 million Americans with private-sector insurance (both individual-market and employer-based) will have access to a list of real-time price information, including cost-sharing, enabling them to know how much care will cost them before going in for treatment,” HHS stated in a press release.

The final rule will require health plans and health insurers to provide easy-to-understand personalized information on member cost-sharing and also disclose the rates paid to health care providers for specific services.

“Price transparency puts patients in control and forces competition on the basis of cost and quality which can rein in the high cost of care,” said Centers for Medicare & Medicaid Services Administrator Seema Verma.

A shopping tool, offered by enrollees’ plans, will create opportunity for consumers to see the negotiated rates between their doctor, health plan or insurer, and associated out-of-pocket costs.

“With more than 70% of the most costly health care services being shoppable, Americans will have vastly more control over their care,” said HHS Secretary Alex Azar.

Under the new rule, plans and insurers will be required to release a standardized, publicly available data file containing regularly updated cost information. This data will create research and comparison opportunities for both consumers and payers. HHS explained that technology companies can create additional price comparison tools that will further incentivize competition.

“The rule also allows insurers that pass on savings to consumers in plans that encourage use of services from lower-cost, higher-value providers, by allowing insurers to take credit for such ‘shared savings’ payments in their medical loss ratio (MLR) calculations beginning with the 2020 MLR reporting year,” stated HHS in the press release.

“This final rule opens the way to greater openness and transparency in our health care system,” said US Secretary of Labor Eugene Scalia. “American workers in employer-sponsored health plans will now have access to real-time, personalized cost-sharing information that empowers them to shop and compare costs between specific providers before receiving care. —Edan Stanley