CMS releases hospital price transparency enforcement update

CMS released a fact sheet on its updated enforcement processes for the Hospital Price Transparency rule. For noncompliant hospitals, the agency will now require corrective action plan (CAP) completion deadlines, impose civil monetary penalties (CMP) earlier and automatically, and streamline the compliance process.

CMS conducts over 200 comprehensive reviews of hospital price transparency compliance per month, according to the fact sheet. As of April 2023, CMS has issued more than 730 warning notices and 269 CAP requests. It has also imposed CMPs on four hospitals for noncompliance.

Although CMS maintained its requirement that noncompliant hospitals submit a CAP within 45 days from the CAP request, it will now require these hospitals to be in full compliance with price transparency guidelines within 90 days from when it issued the request. Previously, hospitals were allowed to propose their own completion date for CMS approval.

“This change will standardize and streamline the timeframe and promote compliance at earlier dates,” said the fact sheet.

In addition, CMS will now automatically impose CMPs on hospitals that do not submit a CAP before the 45-day submission deadline. The agency will also no longer issue a warning notice to hospitals that have not made any attempt to satisfy price transparency requirements. Instead, CMS will immediately request a CAP from those hospitals.

“These enforcement updates will shorten the average time by which hospitals must come into compliance with the hospital price transparency requirements after a deficiency is identified to no more than 180 days, or 90 days for cases with no warning notice,” according to the fact sheet.

The Hospital Price Transparency rule requires hospitals to list all prices online in the form of a machine-readable standard charges file, as well as a consumer-friendly display or tool for the 300 most common shoppable services.

In the latest edition of its semi-annual hospital price transparency report, PatientRightsAdvocate.org found that over three-quarters of hospitals remain noncompliant with federal regulations. To avoid CMPs and other enforcement actions by CMS, organizations must prioritize price transparency compliance. Add price transparency to internal audit plans and ensure all requirements are met for both online formats.

Editor’s note: Find more NAHRI coverage of price transparency here.