Dive Brief:
- The Trump administration last week proposed a new rule that would strengthen price transparency requirements for insurers in an effort to simplify how the data is organized and shared with consumers.
- The proposed rule requires insurers and health plans to track how prices change for some in-network health services and reorganize other data. It also reduces some reporting requirements for insurers in an effort to tamp down on large, unwieldy price data files.
- The Trump administration touted the proposed rule in a Friday press release, with CMS Administrator Dr. Mehmet Oz saying the regulation marked a “giant step” toward simplifying healthcare costs.
Dive Insight:
Boosting price transparency requirements has been a priority of the Trump administration since its first term, when the HHS finalized rules requiring insurers and hospitals to post machine-readable files of pricing information for healthcare services starting in January 2021.
The administration said it hoped the rules would encourage patients to compare options and visit lower-priced facilities, which would incentivize providers to lower costs.
However, compliance — especially among hospitals — has been spotty, and it’s unclear if patients use the new data to compare prices.
For their part, insurers have been more compliant with price transparency requirements, according to research released in October by Turquoise Health. Insurers and health plans are generally good at making accurate negotiated data available, though Turquoise cautioned its research should not be taken as a true measure of compliance, given that only states or HHS can determine that.
Still, existing price transparency regulations for insurers have left some room for ambiguity. For example, although payers have national, regional and statewide networks, regulations have not required plans to identify which posted files correspond to which networks.
In response, insurers and health plans have tended to dump as much information as possible into data files, according to researchers from Turquoise.
The large size of many of the files is “the most prominent challenge” of the machine-readable files, the Trump administration said in the proposed rule, and the file sizes have made it difficult for both patients and health plans to interface with the price data.
Friday’s proposed rule attempts to shrink the file sizes by reducing the frequency of some reporting timelines and the content of reported data. If finalized, insurers would not be required to post in-network rates for some services providers are “unlikely” to perform, according to the regulation. It also reduces the reporting cadence for in-network rates and allowed file amounts from monthly to quarterly.
It also would require insurers to reorganize in-rate files by provider network rather than plan, similar to how most hospitals report data, according to the proposed rule.
Rates will also be made available by phone or paper upon request to ensure information isn’t limited to patients with internet access.
The proposed rate follows a February executive order from President Donald Trump, which directed federal agencies to “rapidly implement and enforce” healthcare price transparency regulations. The order also said the administration would “take all necessary steps” to improve price transparency requirements.
