CMS Finalizes Price Transparency Rule

On Oct. 29, the Department of Health and Human Services, Department of Labor and the Department of the Treasure released the "Transparency in Coverage" final rule. The rule builds on prior proposals to create pricing transparency through disclosure of rates and charges by hospitals, and requires new layers of price transparency from insurers and health plans. Health plans and insurers are now required to: 1) make available to patients the personalized out-of-pocket cost information for services through an online tool, or by mail if requested; and 2) publicly post detailed payment information that shows negotiated rates, historical out-of-network rates and charges, and in-network negotiated rates and historical prices for prescription drug plans.

The out-of-pocket cost disclosures are required for plans beginning Jan. 1, 2023 for 500 shoppable services (listed in Table 1, on page 93). Services for 2023 include ECG, stress test, TTE, SPECT-MPI, E/M, CV rehab, and one cardiac catheterization code (93452). Pacemaker or ICD implantation, PET-MPI, TEE, EP ablations, PCI, stress-echo, CCTA, CMR, the main cardiac catheterization code (93458), TAVR, TMVr, LAAC, and all other services will begin Jan. 1, 2024. Insurers must begin posting the rates and charges starting Jan. 1, 2022 in machine-readable format.

The rule will be relevant for ACC members for financial calculations and to negotiate future rates.

Keywords: ACC Advocacy, Health Expenditures, Insurance Carriers, Centers for Medicare and Medicaid Services (U.S.)


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