CMS issues new guidance to enforce price transparency rule

Two-thirds of largest hospitals aren't complying with price transparency rule

CMS issued new guidance on Github for “developers and consumers of the machine-readable files required through the Transparency in Coverage rule” after an investigation into hospital pricing websites revealed hundreds were using code to block information from showing up on search engines.

In a statement to Modern Healthcare, CMS said they are “committed to ensuring consumers have the information they need to make fully informed decisions regarding their healthcare… and will enforce these rules to make sure Americans know what a hospital charges for health care.”

The new guideline, first posted March 23, says that all uploaded files must be in formats “available to the public without restrictions that would impede the re-use of that information.” On the platform experts are answering questions and providing examples of file layouts and data displays compliant with current price transparency regulations. Prior to the guidance some files were being tagged with code written to keep search engines like Google from indexing names and prices listed on hospital websites. The Wall Street Journal first reported that hundreds of hospitals embedded this code into their sites so that web crawlers could not pick it up, making it difficult for consumers to access.

On Nov. 12, HHS and the departments of Treasury and Labor issued rules to encourage price transparency for consumers to compare varying costs and quality of care. Insurers were required to disclose pricing information such as in-network negotiated rates, billed and out-of-network rates, and in-network drug prices through machine readable files by Jan. 1, 2022. Hospitals were also mandated to publish pricing files such as rates negotiated with payers, but as of early February, 65 of the 100 largest hospitals in the U.S did not comply, according to research by Health Affairs. Many did not put out any files or provided broken links to databases.

Some hospitals have been fighting price transparency regulations, arguing that consumers do not use price estimators to determine their care plans and releasing payer-specific rates could increase prices as the “lowest cost providers adjust to the average.” The American Hospital Association lost a suit to block the rule on the basis that HHS lacks the authority to oversee its regulation and such rates are not useful to consumers. The organization also made a statement calling the regulation a “subjective, oversimplified analysis” of hospital transparency efforts during the pandemic.

Hospitals are required to provide “clear, accessible pricing information online,” according to CMS, and the Hospital Price final rule mandates all machine-readable files and their contents be “accessible without barriers” and “searchable” for consumers. On the new guidance released on Github, CMS says they expect hospitals to comply with these requirements.

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Marie Maynes
Marie Maynes is a Sports enthusiast and writes for the Sports section of ANH.