CMS to require insurers disclose negotiated rates beginning in 2023

CMS to require insurers disclose negotiated rates beginning in 2023

Hospitals and healthcare providers soon won’t be the only ones working to comply with new price transparency requirements after CMS issued a final rule requiring private payers to publicly disclose their negotiated rates beginning in 2023.

The new rule requires insurers in the individual and group markets to both provide easily digestible personalized information on enrollee cost-sharing for healthcare services, and also publicly disclose the rates these payers reimburse providers for specific services, requirements that both payers and providers have voiced their displeasure over.

Beginning Jan. 1, 2023, health plans must provide an online shopping tool that allows consumers to view negotiated rates between their provider and their plan. Additionally, the plan must provide a personalized estimate of the patient’s out-of-pocket cost for 500 of the most popular shoppable items and services.

However, starting Jan. 1, 2022, plans will first be required to publish their pricing data in standardized data files. CMS said it hopes this regulation will spur innovation as developers will have the opportunity to create private products to assist patients with making decisions about their care.

CMS also said this rule is intended to aid people who are uninsured or shopping for health insurance in better understanding how services are priced.

This move is part of a broader effort by the Trump Administration to promote price transparency on the heels of his 2019 executive order to promote transparency for patients. Hospitals must begin publicly disclosing their chargemasters on Jan. 1, 2021.