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CHA Issues Summary of Finalized Health Plan Transparency Policies

For CEOs, CFOs, chief legal counsel, government relations executives, finance staff

CHA has issued a detailed summary, prepared by Health Policy Alternatives, of the final rule issued by the Centers for Medicare & Medicaid Services (CMS) — along with the Departments of Labor and Treasury — that establishes several new price transparency requirements for non-grandfathered group health plans (those not in existence prior to passage of the Affordable Care Act) and health insurers offering non-grandfathered health plans in the individual and group markets.   

The summary describes the requirements of these plans and insurers to: 

  • Make available to participants, beneficiaries, and enrollees personalized out-of-pocket cost information for all covered health care items and services through an internet-based self-service tool and in paper form, upon request, effective Jan. 1, 2023, for an initial list of 500 items and services and Jan. 1, 2024, for all items and services 
  • Publicly disclose in-network provider negotiated rates, out-of-pocket network allowed amounts, and drug pricing information in machine readable data files, effective Jan. 1, 2022 
  • Permit insurers to claim credit for “shared savings” in their medical loss ratio calculations