The Centers for Medicare & Medicaid Services in July proposed a rule that would require hospitals to make pricing information publicly available. It is CMS’s position that the rule would increase competition by enabling patients to shop for health care that meets their needs and budgets.

The proposed rule follows President Donald Trump’s June Executive Order that “lays the foundation for a patient-driven health care system,” according to a press release issued by CMS. Trump’s executive order states, “Opaque pricing structures may benefit powerful special interest groups, such as large hospitals and insurance companies, but they generally leave patients and taxpayers worse off than would a more transparent system.”

Indeed, a statement released by Alex Azar, secretary of U.S. Department of Health and Human Services, noted that “healthcare leaders across the political spectrum have been talking about this need for real transparency for years. This proposal is now the most significant step any president has ever taken to deliver transparency and put patients in control of their care.”

The proposals for calendar year 2020 include changes that would require hospitals to take the following actions:

• Make public “standard charges” for all items and services provided by the hospital.
• Publish standard charges on the internet in a machine-readable file that includes common billing or accounting codes and a description of the item or service. This provides a common framework for comparing standard charges from hospital to hospital.
• Publish payer-specific negotiated charges for common shoppable services (e.g., x-rays, outpatient visits).

To ensure that hospitals comply with the requirements, the rule proposes new enforcement tools including monitoring, auditing, corrective action plans and civil monetary penalties of $300 per day. Additional information, including a list of public comments submitted, may be found on the federal register website at www.federalregister.gov or (https://tinyurl.com/y5zywwhs, comments were due Sept. 27, 2019) or at CMS’s website at www.cms.gov.

To read President Trump’s executive order, visit www.whitehouse.gov and search for “Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First.”