Call it another promise kept by the Trump Administration. Under the direction of President Trump’s Executive Order on Improving Price and Quality Transparency in American Healthcare, the Centers for Medicare and Medicaid Services (CMS) is issuing two new rules to increase price transparency to empower patients and expand competition among all hospitals, group health plans and health insurance issuers in the individual and group markets.
The proposed Transparency in Coverage rule would require most employer-based group health plans and health insurance issuers offering group and individual coverage to disclose price and cost-sharing information to participants, beneficiaries, and enrollees up front. With this information, patients will have accurate estimates of any out-of-pocket costs they must pay to meet their plan’s deductible, co-pay, or co-insurance requirements. This will make previously unavaiable price information accessible to patients for easy comparisons.
The proposed rule also requires health care plans to give consumers real-time, personalized access to cost-sharing information, including an estimate of their cost-sharing liability for all covered healthcare items and services. This requirement would empower consumers to shop and compare costs between specific providers before receiving care. Health plans would also be obliged to disclose their negotiated rates for in-network providers and allowed amounts paid for out-of-network providers.
The Trump Administration is finalizing another rule that will require hospitals to provide patients with clear, accessible information about their “standard charges” for the items and services they provide, making it easier to shop and compare across hospitals. Hospitals will be required to make public payer-specific negotiated charges, the amount the hospital is willing to accept in cash from a patient for an item or service, and the minimum and maximum negotiated charges for 300 common shoppable services in a manner that is consumer-friendly and update the information at least annually.
“Under the status quo, healthcare prices are about as clear as mud to patients,” said CMS Administrator Seema Verma. “Thanks to President Trump’s vision and leadership, we are throwing open the shutters and bringing to light the price of care for American consumers. Kept secret, these prices are simply dollar amounts on a ledger; disclosed, they deliver fuel to the engines of competition among hospitals and insurers. This final rule and the proposed rule will bring forward the transparency we need to finally begin reducing the overall healthcare costs. Today’s rules usher in a new era that upends the status quo to empower patients and put them first.”
Andrew Mangione is Senior Vice President for AMAC’s advocacy affiliate, AMAC Action. He leads AMAC’s grassroots efforts, represents AMAC’s membership in Washington, D.C., and helps chart the association’s policy course. He also serves as a national spokesperson.