August 01, 2019

CMS Proposes New Hospital Pricing Transparency Requirements for 2020

On July 29, 2019, pursuant to the President's recent health quality and pricing transparency executive order, CMS published a proposed hospital price transparency rule for calendar year 2020 that implements Section 2718(e) of the Public Health Service Act and improves upon prior agency guidance that required hospitals to make public their standard charges upon request starting in 2015  and subsequently online in a machine-readable format starting in 2019. Section 2718(e) requires each hospital operating within the United States to publish an annual list of the hospital’s standard charges for items and services provided by the hospital.  The rule proposes: (1) definitions of “hospital”, “standard charges”, and “items and services”; (2) requirements for making public a machine-readable file online that includes all standard charges for all hospital items and services; (3) requirements for making public payer-specific negotiated charges for a limited set of ‘shoppable’ services  that are displayed and packaged in a consumer-friendly manner; and (4) monitoring for hospital noncompliance and actions to address hospital noncompliance, and a process for hospitals to appeal these penalties.