Breaking News – Provider Rate Transparency

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The Trump administration on Thursday issued its final rule requiring nearly all health insurers and self-insured plans to disclose pricing and cost-sharing information.

The Transparency in Coverage rule will force employer health plans and insurance companies to post in-network and out-of-network rates they negotiate with providers. It also requires insurers to develop online price transparency tools to give patients cost-sharing information.

CMS Administrator Seema Verma said in a statement. “Price transparency puts patients in control and forces competition on the basis of cost and quality, which can rein in the high cost of care. CMS’ action represents perhaps the most consequential healthcare reform in the last several decades.”

Hospitals are supposed to start sharing prices in January after losing a court fight in which the American Hospital Association claimed a similar rule violated the hospitals’ First Amendment rights.

If insurers pass on savings to consumers in plans that encourage the use of services from lower-cost, higher-value providers, CMS will allow them to take credit for shared-savings payments in their medical loss ratio calculations starting in 2020.

To learn more visit:

https://www.cms.gov/newsroom/fact-sheets/transparency-coverage-final-rule-fact-sheet-cms-9915-f

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