/ en Sun, 15 Jun 2025 00:53:32 -0500 Tue, 27 May 25 16:06:40 -0500 <div class="container"><div class="row"><div class="col-md-8"><h3><strong>The Centers for Medicare & Medicaid Services’ Hospital Price Transparency final rule goes into effect on Jan. 1, 2021.</strong></h3><h2>Issue</h2><p>The Centers for Medicare & Medicaid Services’ (CMS) hospital price transparency final rule, issued Nov. 14, 2019, will require hospitals to provide an out-of-pocket price estimator tool or information on 300 “shoppable” services for patients as well as disclose their privately negotiated rates with health insurers, discounted cash prices and gross charges beginning Jan. 1, 2021. The agency will monitor and enforce compliance, including civil monetary penalties of up to $300 a day</p><h2>AHA Take</h2><p>Hospitals and health systems are committed to providing patients with meaningful information that patients can use to make the best decisions for themselves and their families, such as an out-of-pocket cost-estimator tool for shoppable services. However, the AHA continues to oppose the requirement to publicly list privately negotiated prices. That part of the rule will do nothing to help patients become more knowledgeable consumers of health care and instead will confuse and frustrate them. And, according to one large national health insurer, it will accelerate anticompetitive behavior by insurers with market power including stymieing badly needed innovations in care delivery.</p><p>The U.S. Court of Appeals for the District of Columbia Circuit Oct.15 heard oral arguments in an appeal from the AHA and hospital groups challenging CMS’ final rule. We urged the court to overturn the rule and do so quickly due to the looming Jan.1 compliance deadline and the unreasonable burden it places on hospitals. Concurrent with our legal strategy, we have been working to prepare the field for the rule’s implementation, should it take effect on Jan. 1.</p><h2>AHA Resources</h2><p>AHA offers resources to help you meet patient demand for easier access to out-of-pocket cost estimates. These resources also can help you implement the hospital price transparency rule shoppable service requirement. We also partnered with AVIA, a digital health consultant firm, and Deloitte to create educational opportunities related to implementation.</p><p>See below for a collection of all AHA and CMS resources related to this final rule. This webpage will be updated regularly as new resources are available.</p><hr><p><a class="ck-anchor" id="ptvideo"></a></p><p>AHA members, <a href="/system/files/media/video/2020/12/AHA-Price-Transparency-Version-A.mp4">download an unbranded version of this video</a> to share with your communities on your website. Use the "Download" or "Save video as" link within the video player option menu to download the .mp4 video file. You may need to right click on the video for this menu to appear.</p><hr><div class="col-md-12 cc_tabs">/* reset */ .cc_tabs ul.a-container { margin: 0; padding: 0; list-style: none; } .cc_tabs input[type=checkbox] { display: none; } /* style */ .cc_tabs .a-container { width: 100%; margin: 20px auto; } .cc_tabs .a-container label { display: block; position: relative; cursor: pointer; font-size: 18px; font-weight: bold; padding: 10px 20px; color: #63666a; background-color: #eee; border-bottom: 1px solid #ddd; -webkit-transition: all .2s ease; -moz-transition: all .2s ease; -ms-transition: all .2s ease; -o-transition: all .2s ease; transition: all .2s ease; margin-bottom:15px } .cc_tabs .a-container label:after { content: ""; width: 0; height: 0; border-top: 8px solid #aaa; border-right: 6px solid transparent; border-bottom: 8px solid transparent; border-left: 6px solid transparent; position: absolute; right: 10px; top: 16px; } .cc_tabs .a-container input:checked + label, .cc_tabs .a-container label:hover { background-color: #003087; 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display: none; height:auto; max-height: 40vh; overflow: auto } .cc_tabs .a-container input:checked ~ .a-content { display: block; } /* Style the tab */ .cc_tabs .tab { background-color: #fff; width: auto; height: auto; overflow: auto; } /* Style the buttons inside the tab */ .cc_tabs .tab button { display: block; background-color: lightgry; color: #003087; padding: 10px 16px 10px 20px; width: calc(50% - 30px); border: solid 1px lightgray; outline: none; text-align: center; cursor: pointer; transition: 0.3s; font-size: 20px; float: left; overflow: auto; margin: 0px 15px; -webkit-border-top-left-radius: 15px; -webkit-border-top-right-radius: 15px; -moz-border-radius-topleft: 15px; -moz-border-radius-topright: 15px; border-top-left-radius: 15px; border-top-right-radius: 15px; font-weight: 700; } @media (max-width:452px){ .cc_tabs .tab button{ padding: 10px 5px 10px 5px; width: calc(50% - 4px); font-size: 17px; margin: 0px 2px; } } /* Change background color of buttons on hover */ .cc_tabs .tab button:hover { background-color: #003087; color:#fff } /* Create an active/current "tab button" class */ .cc_tabs .tab button.active { background-color: #003087; color: #ffffff } /* Style the tab content */ .cc_tabs .tab .tabcontent { float: left; padding: 15px 12px; border: 1px solid #ccc; width: 100%; height: auto; } .cc_tabs .tablinks:after { content: '\2610'; color: #777; font-weight: bold; float: right; margin-left: 5px; } .cc_tabs .tablinks.active:after { content: "\2611"; } Get CertifiedRecertify </div> --> <div class="tabcontent" id="General"> <a id="patienttools"> </a> <a id="patienttools"></a> <ul class="a-container"> <li class="a-items"> Rule Summary <div class="a-content"> <ul> <li> <a href="/special-bulletin/2021-11-03-cms-issues-hospital-outpatientasc-final-rule-including-modifications">Special Bulletin: CY 2022 Hospital OPPS/ASC Final Rule, Including Modifications to Price Transparency </a> </li> <li> <a href="/advisory/2021-07-30-cy-2022-hospital-oppsasc-proposed-rule-including-modifications-price">CY 2022 Hospital OPPS/ASC Proposed Rule, Including Modifications to Price Transparency</a> </li> <li> <a href="/2021-07-20-cms-issues-hospital-outpatientasc-proposed-rule-including-modifications-price">AHA Special Bulletin on Proposed Updates to Rule</a> </li> <li> <a href="/advisory/2019-12-04-regulatory-advisory-administration-finalizes-rule-requiring-disclosure-hospital">AHA Regulatory Advisory</a> </li> <li> <a href="/special-bulletin/2019-11-15-special-bulletin-administration-issues-two-rules-disclosure-hospital">AHA Special Bulletin</a> </li> </ul> </div> </li> <li class="a-items"> AHA Advocacy <div class="a-content"> <ul> <li> <a href="/lettercomment/2021-03-16-aha-comments-no-surprises-acts-price-transparency-provisions">AHA letter to CMS on Implementing the No Surprises Act’s Price Transparency Provisions </a> </li> <li> <a href="/lettercomment/2021-01-07-aha-urges-hhs-exercise-enforcement-discretion-respect-hospital-price">AHA Letter Urging Sec. Azar to Exercise Enforcement Discretion with Respect to the Hospital Price Transparency Rule</a> </li> <li> <a href="/special-bulletin/2020-12-21-aha-urges-court-delay-implementation-price-transparency-rule">AHA Special Bulletin: AHA Urges Court to Delay Implementation of Price Transparency Rule; Asks Biden Transition Team for Enforcement Discretion</a> </li> <li> <a href="/lettercomment/2020-12-21-aha-letter-biden-harris-transition-team-price-transparency-rule">AHA Letter to Biden-Harris Transition Team on Price Transparency Rule</a> </li> <li> <a href="/lettercomment/2020-12-11-aha-outlines-initial-policy-priorities-biden-administration">AHA Letter to President-elect Biden (includes request for delay in enforcement)</a> </li> <li> <a href="/lettercomment/2020-12-02-aha-hhs-re-additional-covid-19-flexibilities-providers">Letter to Sec. Azar re: Additional COVID-19 Flexibilities (includes request for delay in enforcement)</a> </li> <li> <a href="/system/files/media/file/2019/09/aha-comments-cms-outpatient-pps-asc-proposed-rule-cy-2020-9-27-19.pdf">AHA Comments on the Proposed Policy</a> </li> <li> <a href="/lettercomment/2020-07-06-aha-urges-hhs-delay-effective-date-hospital-price-transparency-rule">AHA Letter requesting a delay</a> </li> </ul> </div> </li> <li class="a-items"> AHA Lawsuit <div class="a-content"> <a> </a> <p class="MsoNormal"> <span></span> </p> <ul> <li> <a href="/system/files/media/file/2020/12/2020-12-23-Appellee-US-Opposition-to-Emergency-Motion-to-Stay.pdf">Appellee U.S. Opposition to Emergency Motion to Stay</a> (December 23, 2020) </li> <li> <a href="/legal-documents/2020-12-21-hospitals-emergency-motion-stay-re-disclosure-negotiated-rates">Hospitals’ Emergency Motion for Stay </a>(December 21, 2020) <ul> <li> <a href="/system/files/media/file/2020/12/hospitals-emergency-motion-for-stay-disclosure-of-negotiated-rates-12-21-2020-ex-1.pdf">Exhibit 1</a> </li> <li> <a href="/system/files/media/file/2020/12/hospitals-emergency-motion-for-stay-disclosure-of-negotiated-rates-12-21-2020-ex-2.pdf">Exhibit 2</a> </li> <li> <a href="/system/files/media/file/2020/12/hospitals-emergency-motion-for-stay-disclosure-of-negotiated-rates-12-21-2020-ex-3.pdf">Exhibit 3</a> </li> </ul> </li> </ul> <ul> <li> <a href="/legal-documents/2020-10-02-hospital-group-responds-governments-notice-about-recent-guidance-oct-2">Hospital Group Responds to Government’s Notice About Recent Guidance </a>(October 2, 2020) </li> <li> <a href="/legal-documents/2020-10-02-government-notifies-court-recently-released-guidance-negotiated-charges">Government Notifies Court of Recently Released Guidance on Negotiated Charges Rule Implementation </a>(October 1, 2020) </li> <li> <a href="/legal-documents/2020-10-02-government-responds-hospital-group-letter-executive-order-oct-1-2020">Government Responds to Hospital Group Letter on the Executive Order </a>(October 1, 2020) </li> <li> <a href="/legal-documents/2020-09-28-hospital-group-notifies-court-recent-price-transparency-executive-order">Hospital Group Notifies Court of Recent Price Transparency Executive Order </a>(September 25, 2020) </li> <li> <a href="/legal-documents/2020-09-28-govt-responds-hospital-groups-previous-notice-court-re-additional">Govt. Responds to Hospital Groups’ Previous Notice to the Court about Additional Disclosure Required In 2021 IPPS Final Rule </a>(September 25, 2020) </li> <li> <a href="/legal-documents/2020-09-21-hospital-group-notifies-court-relevant-supplemental-authority-re">Hospital Group Notifies Court of Relevant Supplemental Authority </a>(September 21, 2020) </li> <li> <a href="/legal-documents/2020-08-28-hospital-groups-reply-government-re-disclosure-negotiated-charges-august">Hospital Groups Reply to Government </a>(August 28 2020) </li> <li> <a href="/legal-documents/2020-08-14-governments-reply-brief-negotiated-charges-appeal-august-14-2020">Government’s Reply Brief In Negotiated Charges Appeal</a> (August 14, 2020) </li> <li> <a href="/amicus-brief/2020-07-24-hospital-associations-amicus-brief-negotiated-charges-appeal-july-24-2020">Hospital Associations Amicus Brief in Negotiated Charges Appeal</a> (July 24, 2020) </li> <li> <a href="/amicus-brief/2020-07-24-us-chamber-amicus-brief-negotiated-charges-appeal-july-24-2020">US Chamber Amicus Brief in Negotiated Charges Appeal</a> (July 24, 2020) </li> <li> <a href="/amicus-brief/2020-07-24-hfma-amicus-brief-negotiated-charges-appeal-july-24-2020">HFMA Amicus Brief in Negotiated Charges Appeal</a> (July 24, 2020) </li> <li> <a href="/legal-documents/2020-07-17-opening-appeals-brief-re-disclosure-negotiated-charges-july-17-2020">Opening Appeals Brief</a> (July 17, 2020) </li> <li> <a href="/legal-documents/2020-07-06-dc-circuits-order-adopting-aha-recommended-expedited-briefing-schedule">D.C. Circuit’s Order Adopting AHA Recommended Expedited Briefing Schedule for Appeal</a> (July 7, 2020) </li> <li> <a href="/legal-documents/2020-07-06-motion-expedite-appeal-july-3-2020">Motion to Expedite Appeal</a> (July 3, 2020) </li> <li> <a href="/legal-documents/2020-06-24-notice-appeal-court-decision-public-disclosure-negotiated-rates-june-23">Notice of Appeal</a> (June 23, 2020) </li> <li> <a href="/legal-documents/2020-06-23-court-decision-disclosure-negotiated-charges-lawsuit-june-23-2020">Court Decision in Disclosure of Negotiated Charges Lawsuit</a> (June 23, 2020) </li> <li> <a href="/legal-documents/2020-04-28-governments-reply-brief-disclosure-negotiated-charges-lawsuit-march-24">Government’s Reply Brief in Disclosure of Negotiated Charges Lawsuit</a> (March 24, 2020) </li> <li> <a href="/system/files/media/file/2020/03/court-sets-april-22-hearing-date-aha-challenge-to-rule-requiring-hospitals-disclose-negotiated-charges-3-5-2020.pdf">Court Sets April 22 Hearing Date in AHA’s Challenge to the Rule Requiring Hospitals to Disclose Negotiated Charges</a> (March 5., 2020) </li> <li> <a href="/system/files/media/file/2020/03/us-chamber-commerce-files-amicus-brief-supporting-legal-challenge-rule-requiring-disclosure-of-negotiated-charges-2-28-2020.pdf">US Chamber of Commerce Files Amicus Brief Supporting Legal Challenge to Rule Requiring Disclosure of Negotiated Charges</a> (Feb. 28. 2020) </li> <li> <a href="/system/files/media/file/2020/03/aha-reply-brief-case-to-prevent-disclosure-negotiated-contracts-2-28-2020.pdf">AHA Reply Brief in Case to Prevent Disclosure of Negotiated Contracts</a> (Feb. 28, 2020) </li> <li> <a href="/legal-documents/2020-02-28-amicus-brief-37-state-hospital-associations-support-plaintiffs-motion">Amicus Brief of the State Hospital Associations in Support of AHA Lawsuit Challenging Disclosure of Negotiated Charges Rule</a> (Feb. 28, 2020) </li> <li> <a href="/system/files/media/file/2020/02/government-moves-for-summary-judgement-in-disclosure-of-negotiated-charges-lawsuit-2-4-2020.pdf">Government Moves for Summary Judgement in Disclosure of Negotiated Charges Lawsuit</a> (Feb. 4, 2020) </li> <li> <a href="/system/files/media/file/2019/12/scheduling-order-signed-by-judge-nichols-12-18-19.pdf">Scheduling Order Signed by Judge Nichols</a> (Dec. 18, 2019) </li> <li> <a href="/system/files/media/file/2019/12/joint-motion-for-scheduling-order-disclosure-of-negotiated-charges-12-13-19-.pdf">Joint Motion for Scheduling Order</a> (December 13, 2019) </li> <li> <a href="/system/files/media/file/2019/12/aha-hospital-group-brief-in-support-of-their-motion-for-summary-judgment-disclosure-of-negotiated-charges-12-9-19.pdf">AHA, Hospital Group Brief in Support of Their Motion for Summary Judgment</a> (Dec. 9, 2019) </li> <li> <a href="/system/files/media/file/2019/12/hospital-groups-lawsuit-over-illegal-rule-mandating-public-disclosure-individually-negotiated-rates-12-4-19.pdf%20.pdf">Hospital Groups File Lawsuit Over Illegal Rule Mandating Public Disclosure of Individually Negotiated Rates</a>, (December 4, 2019) </li> </ul> </div> </li> <li class="a-items"> AHA Member Resources for Implementation <div class="a-content"> <h4> Internal Communications Tools for Hospitals </h4> <ul> <li> <a href="/2024-04-18-webinar-recording-navigating-implementation-hospital-price-transparency-machine-readable-file-changes-cms">Webinar Recording: Navigating Implementation of the Hospital Price Transparency Machine-readable File Changes with CMS</a> </li> <li> <a href="/other-resources/2020-12-17-price-transparency-action-items">Price Transparency Action Items</a> </li> <li> <a href="/infographics/2020-12-17-communicating-about-price-transparency">Communicating About Price Transparency</a> </li> <li> <a href="/infographics/2020-12-22-hospital-price-transparency-infographic">Price Transparency Infographic</a> </li> <li> <a href="/2020-12-18-price-transparency-sample-patient-and-media-messages">Price Transparency Sample Patient and Media Messages</a> </li> <li> <a href="/other-resources/2020-12-17-price-transparency-secret-shopper-exercise">Price Transparency Secret Shopper Exercise</a> </li> <li> <a href="/assessment/2020-12-17-price-transparency-self-assessment">Price Transparency Self-assessment</a> </li> <li> <a href="/2020-12-18-price-transparency-tough-questions-answers">Price Transparency Tough Questions and Answers</a> </li> </ul> <h4> Other Resources </h4> <ul> <li> <a href="/special-bulletin/2021-08-23-departments-hhs-labor-and-treasury-release-faqs-transparency-no">AHA Special Bulletin: Departments of HHS, Labor, and Treasury Release FAQs on Transparency, No Surprises Act Regulations</a> </li> <li> <a href="/special-bulletin/2021-08-11-updated-aha-guidance-hospital-price-transparency-rule-took-effect-jan-1">AHA Special Bulletin: Updated AHA Guidance on Hospital Price Transparency Rule That Took Effect Jan. 1 </a> </li> <li> <a href="/advisory/2021-05-03-cms-begins-issuing-warning-notices-hospitals-noncompliance-hospital-price">AHA Member Advisory: CMS Begins Issuing Warning Notices to Hospitals for Noncompliance with Hospital Price Transparency Rule</a> </li> <li> <a href="/advisory/2020-12-22-media-guidance-and-other-new-resources-available-prepare-hospital-price">AHA Member Advisory: Media Guidance and Other New Resources Available to Prepare for Hospital Price Transparency Rule That Takes Effect Jan. 1, Dec. 22, 2020 </a> </li> <li> <a href="/podcasts/2020-12-03-podcast-price-transparency-and-out-pocket-calculators">Podcast: Price Transparency and Out-of-pocket Calculators</a> </li> <li> <a href="/webinars/2020-11-05-webinar-strategies-and-solutions-cleverley-associates-prepare-cmss-hospital">Cleverley + Associates Webinar on Strategies and Solutions</a> </li> <li> <a href="/webinars/2020-11-05-webinar-strategies-and-solutions-para-healthcare-analytics-prepare-cmss">PARA Healthcare Analytics Webinar on Strategies and Solutions</a> </li> <li> <a href="/2020-10-30-hospital-price-transparency-rule-goes-effect-jan-1-aha-resources-help-members-prepare">AHA Member Advisory</a> </li> <li> <a href="/2020-10-27-patient-cost-estimator-toolkit">Patient Out-of-pocket Cost Estimator Toolkit </a>(includes Members in Action case studies) </li> <li> <a href="https://connect.aviahealthinnovation.com/intelligence/km/graph?id=2226&activeTab=Feed">AVIA Connect Virtual Panel on Implementation</a> (access granted with AHA.org log-in information) </li> <li> <a href="https://aviahealthinnovation.zoom.us/rec/play/X1jytuRlrriT9np6MLgNeyKsOT7PuPsHZN6N0vqZ6qVielWRFjTsTRfTqh8WUSzb3NCuD_zWdkpRPnGH.pluDldINDeHoG2o3?startTime=1600887611000">AVIA-Deloitte Webinar on Strategic Considerations for Implementation</a> (access granted with AHA.org log-in information) </li> <li> <a href="/advocacy-webinar-recording/2021-08-30-webinar-price-transparency-policy-updates">Webinar: Price Transparency Updates on August 25, 2021</a> </li> </ul> </div> </li> <li class="a-items"> CMS Resources <div class="a-content"> <ul> <li> <a href="https://www.cms.gov/hospital-price-transparency/hospitals">CMS Hospital Transparency Website</a> </li> <li> <a href="https://www.govinfo.gov/content/pkg/FR-2019-11-27/pdf/2019-24931.pdf">FY 2020 Price Transparency Requirements for Hospitals To Make Standard Charges Public</a> </li> <li> <a href="https://www.cms.gov/files/document/hospital-price-transparency-frequently-asked-questions.pdf">Frequently Asked Questions</a> </li> <li> <a href="https://www.cms.gov/files/document/steps-machine-readable-file.pdf">8 Steps to a Machine-readable File</a> </li> <li> <a href="https://www.cms.gov/files/document/steps-making-public-standard-charges-shoppable-services.pdf">10 Steps to a Consumer-Friendly Display</a> </li> <li> <a href="https://www.cms.gov/files/document/hospital-price-transparency-final-rule-quick-reference-checklists.pdf">Quick Reference Checklist</a> </li> </ul> </div> </li> <li class="a-items"> AHA Resources on Related Policies <div class="a-content"> <ul> <li> <a href="/advisory/2021-10-26-member-advisory-update-federal-price-transparency-policies">Member Advisory: Update on Federal Price Transparency Policies </a> </li> <li> <a href="/surprise-billing">AHA’s Surprise Billing Webpage </a> </li> <li> <a href="/special-bulletin/2020-10-29-administration-finalizes-rule-requiring-health-plans-disclose">Special Bulletin: Administration Finalizes Rule Requiring Health Plans to Disclose Negotiated Rates</a> </li> <li> <a href="/special-bulletin/2019-11-15-special-bulletin-administration-issues-two-rules-disclosure-hospital">Special Bulletin: Proposed Insurer Price Transparency Policy</a> </li> <li> <a href="/lettercomment/2020-01-29-aha-comments-cms-transparency-coverage-proposed-rule">AHA comments on Proposed Insurer Price Transparency Policy</a> </li> <li> <a href="/system/files/2018-12/181211-advisory-transparency.pdf">AHA Advisory – 2019 Update to Disclosure of Standard Charge Policy</a> </li> </ul> </div> </li> </ul> </div> <ul class="a-container"> item 1 <div class="a-content"> <p> ==== </p> </div> </li> </ul> <div> --> function openCity(evt, cityName) { var i, tabcontent, tablinks; tabcontent = document.getElementsByClassName("tabcontent"); for (i = 0; i < tabcontent.length; i++) { tabcontent[i].style.display = "none"; } tablinks = document.getElementsByClassName("tablinks"); for (i = 0; i < tablinks.length; i++) { tablinks[i].className = tablinks[i].className.replace(" active", ""); } document.getElementById(cityName).style.display = "block"; evt.currentTarget.className += " active"; } // Get the element with id="defaultOpen" and click on it document.getElementById("defaultOpen").click(); </div> </div><p> </p></div> <ul class="a-container"> item 1 <div class="a-content"> <p> ==== </p> </div> </li> </ul> <div> --> function openCity(evt, cityName) { var i, tabcontent, tablinks; tabcontent = document.getElementsByClassName("tabcontent"); for (i = 0; i < tabcontent.length; i++) { tabcontent[i].style.display = "none"; } tablinks = document.getElementsByClassName("tablinks"); for (i = 0; i < tablinks.length; i++) { tablinks[i].className = tablinks[i].className.replace(" active", ""); } document.getElementById(cityName).style.display = "block"; evt.currentTarget.className += " active"; } // Get the element with id="defaultOpen" and click on it document.getElementById("defaultOpen").click(); </div></div><div class="col-md-4"><p class="text-align-center"> </p><p class="text-align-center"> </p><p class="text-align-center"><a class="btn btn-primary btn-wide" href="/advisory/2020-12-22-media-guidance-and-other-new-resources-available-prepare-hospital-price"><strong>December 22 AHA Advisory with New Resources to Prepare for Hospital Price Transparency Rule That Takes Effect Jan. 1</strong></a></p><p> </p><div class="panel module-typeC"><div class="panel-heading"><h3 class="panel-title">Key Takeaways</h3></div><div class="panel-body"><p>As of Jan. 1, 2021, hospitals are required to:</p><ul><li>Post a list of five types of standard charges – now defined as gross charges, payer-specific negotiated rates, de-identified minimum and maximum negotiated rates, and discounted cash price – for all items and services in a machine-readable format on their websites.</li><li>Provide payer-specific rates for at least 300 “shoppable” bundles of services in a consumer-friendly format. Hospitals with a qualified price estimator tool meet this requirement.</li></ul><p>Noncompliance is subject to civil monetary penalties.</p><p>The AHA and three other national organizations sued the federal government challenging the final rule; the case is pending an appeal.</p></div></div></div></div></div> Mon, 12 Apr 2021 16:34:23 -0500 Price Transparency <div class="container"><div class="row"><div class="col-md-8"><p>The Departments of Labor, Health and Human Services, and the Treasury last week <a href="https://www.cms.gov/newsroom/press-releases/departments-labor-health-and-human-services-treasury-announce-move-strengthen-healthcare-price" title="Original URL: https://email.advocacy.aha.org/NzEwLVpMTC02NTEAAAGamPoobTykTl-7UWk9Aq_FCPDmvKVQm1NiC4yrfUT5irYfuTpqwsGoI9H2Ke-FprifWnEbC-w=. Click or tap if you trust this link.">released</a> several new guidance documents and requests for information (RFIs) on price transparency, following the February <a href="/news/headline/2025-02-26-administration-issues-executive-order-hospital-price-transparency" title="Original URL: https://email.advocacy.aha.org/NzEwLVpMTC02NTEAAAGamPoobZhvM6A6LPvxeyjTzOnFzUO3Do1TH7HM58st2c2MCd9eQbpWlVPj182ndkyQ6gAJj9M=. Click or tap if you trust this link.">executive order</a> on the same subject.</p><p>As part of this package, the Centers for Medicare & Medicaid Services (CMS) released <a href="https://www.cms.gov/files/document/updated-hpt-guidance-encoding-allowed-amounts.pdf">new guidance</a> on calculating the estimated allowed amount values in the hospital machine-readable files. Whenever possible, hospitals should continue to use the average dollar amount received over the last 12-month period (or less, if the payment methodology was only used for part of the year), which should be derived from the electronic remittance data. However, going forward, if there is not enough historic data to calculate an average, hospitals should use an expected payment amount, encoded as a dollar figure. This replaces previous guidance that allowed hospitals to use a code of nine 9s to signify that there was not sufficient historic data for that item or service over the last year. In the guidance, CMS expressed its concern that the machine-readable files featured nine 9s more frequently than expected.</p><p>At the same time, CMS released an <a href="https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/accuracy-and-completeness-rfi">RFI</a> on hospital price transparency that seeks stakeholder input on assessing the accuracy and completeness of the machine-readable files. The RFI includes the following questions:</p><ol><li>Should CMS specifically define the terms “accuracy of data” and “completeness of data” in the context of these requirements, and if yes, then how?</li><li>What are your concerns about the accuracy and completeness of the hospital price transparency machine-readable file data? Please be as specific as possible.</li><li>Do concerns about accuracy and completeness of the machine-readable file data affect your ability to use hospital pricing information effectively? For example, are there additional data elements that could be added, or others modified, to improve your ability to use the data? Please provide examples.</li><li>Are there external sources of information that may be leveraged to evaluate the accuracy and completeness of the data in the machine-readable files? If so, please identify those sources and how they can be used.</li><li>What specific suggestions do you have for improving the hospital price transparency compliance and enforcement processes to ensure that the hospital pricing data is accurate, complete and meaningful? For example, are there any changes that CMS should consider making to the CMS validator tool, which is available to hospitals to help ensure they are complying with hospital price transparency requirements, so as to improve accuracy and completeness?</li><li>Do you have any other suggestions for CMS to help improve the overall quality of the hospital price transparency machine-readable file data?</li></ol><p>The Departments of Labor, Health and Human Services, and the Treasury also released additional guidance for insurers, including <a href="https://www.cms.gov/files/document/aca-faqs-part-70.pdf">announcing</a> that there would be a new schema for the insurer machine-readable file that would reduce the file size by decreasing duplicative data, resulting in more useable files, and an <a href="https://www.dol.gov/sites/dolgov/files/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/rfi-regarding-prescription-drug-machine-readable-file-requirement-in-the-transparency-in-coverage-final-rule.pdf">RFI</a> on improving prescription drug price transparency.</p><h2>NEXT STEPS</h2><p>Responses to the Transparency in Coverage Prescription Drug Price Transparency RFI are due 30 days following publication in the Federal Register. Responses to the Hospital Price Transparency RFI are due July 21, 2025.</p><h2>FURTHER QUESTIONS</h2><p>If you have further questions, please contact the AHA at 800-424-4301.</p><p> </p></div><div class="col-md-4"><a href="/system/files/media/file/2025/05/departments-release-new-guidance-rfis-on-hospital-and-insurer-price-transparency-advisory-5-27-2025.pdf"><img src="/sites/default/files/inline-images/cover-departments-release-new-guidance-rfis-on-hospital-and-insurer-price-transparency-advisory-5-27-2025.png" data-entity-uuid="931300c2-58d4-4568-be2d-fc526efb5a11" data-entity-type="file" width="640" height="828" alt="Cover Image of Departments Release New Guidance, RFIs on Hospital and Insurer Price Transparency Advisory"></a></div></div></div> Tue, 27 May 2025 16:06:40 -0500 Price Transparency /news/headline/2025-05-22-cms-releases-new-guidance-rfis-hospital-and-insurer-price-transparency <p>The Departments of Labor, Health and Human Services, and the Treasury May 22 <a href="https://www.cms.gov/newsroom/press-releases/departments-labor-health-and-human-services-treasury-announce-move-strengthen-healthcare-price" target="_blank">released</a> several new guidance documents and requests for information on price transparency, following the February <a href=/news/headline/2025-02-26-administration-issues-executive-order-hospital-price-transparency" target="_blank">executive order</a> on the same subject. As part of this package, CMS released new <a href="https://www.cms.gov/files/document/updated-hpt-guidance-encoding-allowed-amounts.pdf" target="_blank">guidance</a> on calculating the estimated allowed amount values in the hospital machine-readable files. Whenever possible, hospitals should use the average dollar amount received over the last 12-month period (or less, if the payment methodology was only used for part of the year), which should be derived from the electronic remittance data. If there is no historic data, hospitals should use the expected payment amount, encoded as a dollar figure. This replaces previous guidance which allowed hospitals to use a code of nine number nines to signify that there was not sufficient historic data for that item or service over the last year. CMS also released an <a href="https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/accuracy-and-completeness-rfi" target="_blank">RFI</a> on hospital price transparency accuracy and completeness. Comments are due July 21. The AHA plans to submit comments.  </p><p>The departments also released a <a href="https://www.cms.gov/files/document/aca-faqs-part-70.pdf" target="_blank">FAQ document</a>, announcing that a new standard format for the insurer machine-readable files will be released Oct. 1, 2025. The new format aims to reduce the file size of the insurer files by decreasing duplicative data. In addition, the departments issued an <a href="https://www.dol.gov/sites/dolgov/files/ebsa/laws-and-regulations/laws/affordable-care-act/for-employers-and-advisers/rfi-regarding-prescription-drug-machine-readable-file-requirement-in-the-transparency-in-coverage-final-rule.pdf" target="_blank">RFI</a> on improving prescription drug price transparency as part of the Transparency in Coverage, or insurer transparency rule.<br><br><br> </p> Thu, 22 May 2025 15:58:06 -0500 Price Transparency /news/headline/2025-04-11-cms-releases-agenda-new-administrator-mehmet-oz <p>The Centers for Medicare & Medicaid Services April 10 released key <a href="https://www.cms.gov/newsroom/press-releases/dr-mehmet-oz-shares-vision-cms">priorities</a> for new CMS Administrator Mehmet Oz, who was confirmed to the position April 3. They include implementing the Trump administration’s Feb. 25 <a href="https://www.whitehouse.gov/presidential-actions/2025/02/making-america-healthy-again-by-empowering-patients-with-clear-accurate-and-actionable-healthcare-pricing-information/">executive order</a> on improving and increasing enforcement of existing hospital and insurer price transparency requirements. Other priorities include holding providers accountable for health outcomes, streamlining access to life-saving treatments, fostering prevention and chronic disease treatment and stopping wasteful spending, fraud and abuse. </p> Fri, 11 Apr 2025 14:46:53 -0500 Price Transparency /news/headline/2025-02-26-administration-issues-executive-order-hospital-price-transparency <p>The White House yesterday issued an <a href="https://www.whitehouse.gov/presidential-actions/2025/02/making-america-healthy-again-by-empowering-patients-with-clear-accurate-and-actionable-healthcare-pricing-information/" title="exec order">executive order</a> that directs the Departments of Health and Human Services, Labor, and Treasury to improve upon and increase enforcement of the hospital and insurer price transparency requirements in the Hospital Price Transparency and Transparency in Coverage regulations. Specifically, the White House instructs the departments to “rapidly implement and enforce” the regulations, including by taking actions in the next 90 days to increase enforcement and standardization and ensure that “actual prices,” rather than estimates are disclosed.</p> Wed, 26 Feb 2025 15:02:56 -0600 Price Transparency <div class="container"><div class="row"><div class="col-md-8"><p>The White House Feb. 25 issued an <a href="https://www.whitehouse.gov/presidential-actions/2025/02/making-america-healthy-again-by-empowering-patients-with-clear-accurate-and-actionable-healthcare-pricing-information/">executive order</a> that directs the Departments of Health and Human Services, Labor, and Treasury to improve upon and increase enforcement of the hospital and insurer price transparency requirements in the Hospital Price Transparency and Transparency in Coverage regulations. The Administration directs the departments to "identify opportunities to further empower patients with meaningful price information, potentially including through the expansion of existing price transparency requirements" and notes that such efforts also could reduce employers’ health care costs. Additional information can be found in the White House <a href="https://www.whitehouse.gov/fact-sheets/2025/02/fact-sheet-president-donald-j-trump-announces-actions-to-make-healthcare-prices-transparent/">fact sheet</a>.</p><p>Specifically, the White House instructs the departments to “rapidly implement and enforce” the regulations, including by taking actions in the next 90 days to:</p><ul><li>Ensure that “actual prices” are being disclosed, rather than estimates.</li><li>Issue additional guidance on standardization of pricing information, with a focus on easy comparability between hospital and insurer data.</li><li>Increase enforcement.</li></ul><p>The executive order, however, did not provide specifics on what those actions may be. The AHA will continue to monitor this issue and provide additional updates as needed.</p><h2>ADDITIONAL INFORMATION ON EXECUTIVE ACTIONS</h2><p>The Trump administration has issued a series of executive orders and administrative actions that reinforce the administration’s priorities. The AHA has compiled a <a href="/system/files/media/file/2025/01/2025-New-Executive-Orders-20250127.pdf">tracker</a> of the actions the administration has taken that may be of interest to hospitals and health systems. The tracker will be updated regularly as new actions are released.</p><h2>FURTHER QUESTIONS</h2><p>If you have further questions, please contact the AHA at 800-424-4301.</p></div><div class="col-md-4"><a href="/system/files/media/file/2025/02/administration-releases-executive-order-on-health-care-price-transparency-advisory-2-26-2025.pdf"><img data-entity-uuid="30c40424-d881-40b8-b7fa-92943970205a" data-entity-type="file" src="/sites/default/files/inline-images/cover-administration-releases-executive-order-on-health-care-price-transparency-advisory-2-26-2025.png" width="640" height="834"></a></div></div></div> Wed, 26 Feb 2025 14:43:04 -0600 Price Transparency /news/headline/2024-10-29-webinar-recording-available-2025-hospital-price-transparency-requirements <p>A recording and other materials are available following last week's Centers for Medicare & Medicaid Services' <a href="https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/resources">webinar</a> on meeting new hospital price transparency requirements that become effective Jan. 1. The <a href="/news/headline/2024-07-01-new-hospital-price-transparency-requirements-take-effect">requirements</a> incorporate additional elements into the standard machine-readable format, including an estimated allowed amount and information on modifiers and prescription drugs.</p> Tue, 29 Oct 2024 16:20:30 -0500 Price Transparency /news/headline/2024-10-16-cms-hosting-webinar-next-week-price-transparency-machine-readable-file-2025-requirements <p>The Centers for Medicare & Medicaid Services Oct. 21 is hosting a <a href="https://cms.zoomgov.com/webinar/register/WN_LqZfybX7RAePe8DAPEyx3w#/registration">webinar</a> on meeting its new hospital price transparency requirements becoming effective Jan. 1. The <a href="/news/headline/2024-07-01-new-hospital-price-transparency-requirements-take-effect">requirements</a> include incorporating additional elements into the standard machine-readable format, including an estimated allowed amount and information on modifiers and prescription drugs.</p> Wed, 16 Oct 2024 14:37:26 -0500 Price Transparency /news/headline/2024-10-07-reminder-cms-hosting-webinar-oct-21-price-transparency-machine-readable-file-2025-requirements <p>The Centers for Medicare & Medicaid Services Oct. 21 will host a <a href="https://cms.zoomgov.com/webinar/register/WN_LqZfybX7RAePe8DAPEyx3w#/registration">webinar</a> on meeting its new hospital price transparency requirements becoming effective Jan. 1. These <a href="/news/headline/2024-07-01-new-hospital-price-transparency-requirements-take-effect">requirements</a> include incorporating additional elements into the standard machine-readable format, including an estimated allowed amount and information on modifiers and prescription drugs.</p> Mon, 07 Oct 2024 16:07:26 -0500 Price Transparency /news/headline/2024-09-13-cms-host-webinar-2025-hospital-price-transparency-requirements <p>The Centers for Medicare & Medicaid Services Oct. 21 will host a <a href="https://cms.zoomgov.com/webinar/register/WN_LqZfybX7RAePe8DAPEyx3w#/registration">webinar</a> on meeting new hospital price transparency requirements which become effective Jan. 1. The most recent changes became effective <a href="/news/headline/2024-07-01-new-hospital-price-transparency-requirements-take-effect">July 1</a>, which require hospitals to use a standard machine-readable file format, which includes some new data elements, such as the negotiated rate methodology and an accuracy and completeness statement.</p> Fri, 13 Sep 2024 14:27:12 -0500 Price Transparency