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CMS Delays Controversial Hospital Price Transparency Rules

CMS has decided to delay its controversial proposal to require hospitals to post their standard prices based on their negotiated contracts with insurers. But while the delay represents a temporary setback for the agency, the transparency initiative is a long way from dead.

The Transparency Imbroglio

Had it gone through as scheduled, the rule CMS proposed in July 2019 in response to a President Trump executive order, would have extended the new rule requiring hospitals to post their gross charges, i.e., list prices, to the hospital’s negotiated price by specific payer and plan for a set of “shoppable” services, starting on Jan. 1, 2020. Such services could include anything that can be scheduled by a patient in advance. (For more on the proposal, see National Intelligence Report (NIR) Sept. 30, 2019.

After a hailstorm of protest from both providers and payors, CMS has now decided to take the Jan. 1, 2020 active date off the table. “We received over 1,400 comments” on the rule, acknowledged CMS Administrator Seema Varma in a tweet. We intend to summarize and respond to the comments in due time, Varma noted. The agency’s new plan: Issue a rule on pricing transparency alongside a more comprehensive proposal for health plan transparency, an RFI for which has already been issued.

Stay tuned.

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