Final rule released requiring health plans to publicly release their negotiated rates

The Departments of Health and Human Services, Treasury and Labor today released its transparency-in-coverage final rule imposing new requirements upon group health plans and issuers of health insurance coverage in the individual and group markets. The final rule includes disclosure of individualized cost-sharing information to enrollees and public disclosure of negotiated rates. In addition, the rule includes a change to the medical loss ratio that incentivizes insurers to share savings with enrollees who use “lower-cost, higher-value” providers.

“Hospitals and health systems continue to support and actively promote efforts to help patients be more educated consumers of health care by making tools and resources available on their out-of-pocket costs,” AHA today said in a statement. “That effort will not be advanced by today’s announcement of yet another requirement for a data dump of privately negotiated rates that will only confuse and frustrate consumers. Instead, federal agencies should work with the provider and insurer communities to make useful information more accessible to consumers. AHA stands ready to work cooperatively with both to achieve meaningful transparency.”

As part of the rule, health plans will be required to publish and update on a monthly basis three standardized, machine-readable files. The first will include negotiated rates for all covered items and services with all in-network providers. The second will show both the historical payments to, and billed charges from, out-of-network providers with at least 20 payments. The third will detail the in-network negotiated rates and historical net prices for all covered prescription drugs at the pharmacy location level. The rule requires that these file be made public for plan years beginning on or after Jan. 1, 2022.