CMS Insurer Price Transparency Rule Takes Effect
On July 1, 2022, the Centers for Medicare and Medicaid Services (CMS) Insurer Price Transparency Rule enforcement went into effect. It was intended to be in effect as of January 1, 2022, but CMS delayed enforcement for six months to allow payers time to adhere to the regulations, including access to machine-readable files for consumer viewing. The goal of this regulation is to encourage a more competitive market for medical coverage and treatment by making the healthcare prices visible before point of service.
Most private group health insurers must now publicly disclose their in- and out-of-network rates online, and the cost files are required to be updated at least once a month. Violators may be fined up to $100 per day per breach and per patient affected, meaning plans with higher volumes of beneficiaries could face steep penalties. In June 2022, CMS issued fines for noncompliance to two Georgia hospitals, totaling $1.1 million.
