A final rule issued by the Centers for Medicare & Medicaid Services (CMS) will require hospitals to post a comprehensive, machine-readable data file containing all standard charges – including negotiated rates – for all services. Hospitals are also required to post price information online for 300 specific “shoppable services” in a consumer friendly manner. In addition, CMS recently finalized requirements that hospitals report certain payer-specific negotiated rates for inpatient services by MS-DRG on the Medicare cost report.
- January 1, 2021: Hospital price transparency rule goes into effect for all hospitals.
On November 15, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a final rule which finalized provisions related to price transparency requirements for hospitals.
The final rule is effective for all hospitals beginning January 1, 2021 and requires all hospitals to post gross charges, payer-specific negotiated rates, the de-identified minimum and maximum negotiated rates, and the cash discount price for all items and services on a website in a machine-readable format. In addition, it requires posting of information for 300 “shoppable” services in a consumer-friendly manner.
In the federal fiscal year (FFY) 2021 inpatient prospective payment system (IPPS) final rule, CMS built on its price transparency policies by requiring hospitals report the median payer-specific negotiated rates for Medicare Advantage plans by MS-DRG on the Medicare cost report. This policy is effective for cost reporting periods ending January 1, 2021, or after.
- Hospital Price Transparency Final Rule
- CHA Webinar: Hospital Price Transparency Rule – Getting Prepared for January 2021
- Federal Court Ruling (June 2020)
- CMS Hospital Price Transparency Website
- FFY 2021 IPPS Final Rule (Cost Report Price Transparency Provisions)
- Health Plan Price Transparency Final Rule
For questions, contact:
Vice President, Federal Policy
California Hospital Association