HomeHealth Care NewsNew Rule Requires Health Plans to Divulge their Deals with Providers

New Rule Requires Health Plans to Divulge their Deals with Providers

Starting January 1, 2022, the Trump Administration will require private health insurance plans to make public the negotiated rates they have with in- and out-of-network providers and net prices of prescription drugs they have and are covering.

 Additionally, consumers will have access to the out-of-pocket costs for over 500 “shoppable” services” starting January 2023 with an online service tool and for all items and services starting the following January. By January 2024, plans will be required to show costs for remaining procedures, drugs, durable medical equipment, and services.

Two months ago, the Trump Administration put into effect a rule requiring hospitals to divulge their prices starting in January 2021.  A federal appeals court has rejected a challenge to the rule. Opponents of price transparency have argued the rule forces private entities to divulge proprietary information.

 “Don’t be fooled,” Centers for Medicare and Medicaid Services Administrator Seema Verma said in a call with reporters. “This rule merely requires that health insurance companies share the same information as companies in virtually every other industry. Such complaints are all about protecting a considerable profit special interest reaped from business as usual.”

Hospitals failing to comply with the price disclosure rule can face up to a $300 a day fine.

CMS says enforcement of health plan price disclosure will be up primarily to the states. The rule applies to all private health plans, including self-insured plans. Short-term-limited duration insurance plans and health reimbursement arrangements are exempt.

Staff reports


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