CMS Makes Important Price Transparency Improvements

On Monday, October 5, Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. and Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz announced the finalized rule to improve access to health care price information. This action builds upon the federal price transparency requirements to make the information easier to understand, access, and use.

During the first Trump Administration, CMS finalized the hospital and insurance price transparency rules which were a great first step. They require that prices and negotiated rates of services be posted on a publicly available website and displayed in a consumer-friendly way. However, there was little detail on what that looks like, so the data is often hard to find and in released in huge files that are not useful. Enforcement and compliance have also been low. This new rule addresses these issues through multiple structural changes.

For hospitals, they must now publish the actual dollar amounts for allowed charges at the 10^th, 90^th, and median percentile so the data much more useable. They must also add their National Provider Identifiers to their machine‑readable files, which makes matching hospital entities to payer data much easier.

For insurance companies, this new rule bans the use of ghost rates, requires actual dollar amounts for in-network price reporting, expands disclosure of out-of-network prices, and requires that personalized cost-estimates be available over the phone in addition to online tools.

The new rule also increases accountability by requiring both insurance companies and hospitals to identify the names of senior officials who attest that the data is complete and accurate.

Finally, this new rule is streamlining the data and processes to reduce administrative burden and improve usability. Insurance companies will now be required to submit one in‑network rate file per provider network, not per plan, eliminating duplicative files, and the frequency of reporting has been lowered from once a month to once a quarter.

These changes are a huge win towards achieving true price transparency in health care. This improved data will allow companies to create better consumer tools for patients to shop for their care, and for employers to better analyze their health care spending. This will significantly open the health care market, put patients and employers in control of their spending, and create competition among providers and purchasers to offer the best value at the best price.

You can watch the full event announcing the new rule here: