CMS Proposes to Drastically Increase Price Transparency Penalties to Hospitals

Hospitals have been required since January 1, 2021, to publicly post their privately negotiated prices for 300 shoppable services so patients can be more informed while shopping for health care services.  However, with the penalty capped at about $110,000 per hospital per year, a large swath of hospitals have found it easier to not comply and just pay the penalty.  Six months into the new requirements being in effect, the Centers for Medicare and Medicaid Services (CMS) sees the writing on the wall, so on July 19, 2021, they proposed to increase the penalty to closer to $2 million for the largest hospitals.  They’ve assembled a fact sheet and once the rule is published in the federal register, they’ll accept public comment.

As a reminder, employers will be liable to meet similar public disclosure requirements for their own health plans soon, with requirements beginning in phases in 2022, 2023, and 2024.  This proposal may also serve as an impetus to ensure group health plans comply with upcoming transparency disclosure requirements.

IMA will continue to monitor regulator guidance and offer meaningful, practical, timely information.

This material should not be considered as a substitute for legal, tax and/or actuarial advice. Contact the appropriate professional counsel for such matters. These materials are not exhaustive and are subject to possible changes in applicable laws, rules, and regulations and their interpretations.