Executive Order:

Pricing Transparency

At the end of February, President Trump issued an Executive Order directing several federal agencies to further implement, enforce and possibly expand existing federal transparency regulations that target hospitals and insurers. According to the fact sheet, the goal is to empower patients with accurate prices when shopping healthcare services and “help patients and employers get the best deal on healthcare.”

The existing transparency regulations require hospitals and health plans to, amongst other things: (i) publish machine readable files with pricing and reimbursement data; and (ii) provide consumers with price comparison tools. The hope is that further price transparency will help lower healthcare costs over time, but adoption of, and compliance with, the requirements has been slow.

The new executive order does not introduce any immediate changes. However, it is anticipated that further action may be taken through regulations and potentially new legislation. Generally, insurance carriers and third-party administrators (TPAs) manage these requirements on behalf of group health plans. Consequently, employers typically have minimal responsibilities beyond ensuring that their service vendors are in compliance.

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.

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