Comment period extended for proposed rule that would require payers to post negotiated rates

Wednesday, January 15, 2020

The Transparency in Coverage Proposed Rule comment period has been extended from January 14 to January 29, CMS announced. The proposed rule, published November 27, 2019, would require insurers to provide personalized price estimates and publish negotiated in-network rates and historical payment information.

The proposed rule and the Hospital Price Transparency Final Rule, which is aimed at provider organizations and was also published November 2019, have been criticized by payer and provider organizations. America’s Health Insurance Plans (AHIP) released a statement in November 2019 that contended that both the proposed rule and the final rule failed to satisfy patients’ need for useful price information and placed undue burdens on organizations. Publishing payer-specific negotiated prices, which both the proposed and the final rule require, could foster an anticompetitive market, AHIP added.

Organizations and individuals interested in submitting comments on the proposed rule are encouraged to read the rule carefully and make note of specific questions posed in the proposed rule and topics on which CMS is soliciting feedback. Commenters should keep in mind that CMS’ primary concerns are protecting the Medicare Trust Fund and beneficiaries’ well-being. Although the agency is general concerned about burden reduction, with regards to price transparency it has stated that in most cases it believes that the benefits of its requirements outweigh the potential burdens they may place on payer or provider organizations.

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Compliance, News, Revenue Integrity

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