Trump administration releases healthcare price transparency requirements

November 19, 2019
Keith A. Reynolds
Keith A. Reynolds

HHS releases requirements aimed at lowering drug prices and healthcare costs.

President Donald J. Trump’s administration is seeking to bring more price transparency into the healthcare market through a pair of new rules released by HHS on November 15.

The rules are in response to Trump’s June 24 executive order on improving price and quality transparency in the healthcare system. They’re being implemented by the Centers for Medicare & Medicaid Services (CMS) and are aimed at increasing price transparency to increase competition among hospitals, group health plans, and health insurers in the individual and group markets.

"Today's transparency announcement may be a more significant change to American healthcare markets than any other single thing we've done, by shining light on the costs of our shadowy system and finally putting the American patient in control,” HHS Secretary Alex Azar says in the announcement.

The two rules both require pricing information to be made publicly available.

The first rule concerns healthcare pricing, and will be implemented January 1, 2021 and will require hospitals to make public charges for 300 shoppable services available to patients in a “consumer-friendly” manner. CMS will identify 70 services which must be published, and the hospital will choose the other 230.

The other rule, if finalized, will give patients access to their insurers’ cost-sharing liability and disclose the insurers’ negotiated rates for in-network providers and allowed amounts paid for out-of-network physicians.

These rules have already received pushback from healthcare industry groups. The American Hospital Association, Association of American Medical Colleges, Children’s Hospital Association, and Federation of American Hospitals released a joint statement calling the rules a setback and stating their intentions to join in a legal challenge claiming the rule oversteps the administration’s authority.

“Instead of helping patients know their out-of-pocket costs, this rule will introduce widespread confusion, accelerate anticompetitive behavior among health insurers, and stymie innovations in value-based care delivery,” the release says.

Matt Eyles, president and CEO of America’s Health Insurance Plans, also released a statement saying the rules don’t satisfies the group’s principles of patients deserving transparency, transparency should encourage competitive negotiation, and public programs and free markets should work together to make healthcare affordable.

“We will continue to engage collaboratively with the Administration and other health care stakeholders on how we can best work together to achieve lower prices and costs while protecting health care quality, choice, value, and privacy for the hardworking Americans we serve,” he says.