News: CMS proposes new and increasingly complex price transparency requirements for 2024

The Centers for Medicare and Medicaid Services (CMS) has released a newly proposed set of price transparency requirements under the outpatient prospective payment system (OPPS), according to HealthLeaders.

The new set of proposed rules include not only a payment rate change (2.8%), but also a certification requirement for verifying the accuracy and completeness of price data. CMS has also proposed an acknowledgement requirement for hospitals who have received warning notices, as well as a mandate for displaying standard changes data within a specific CMS template.

The Department of Human Health and Services provided a summary of the proposed rules, which reads as follows:

1. “Add definitions for ‘CMS template’, ‘consumer-friendly expected allowed charges’, ‘encode’, and ‘machine-readable file’ (MRF).”
2. “Require hospitals to affirm the accuracy and completeness of data in their MRF.”
3. “Revise and expand the data elements hospitals must include in the MRF.”
4. “Require hospitals to conform to a CMS template layout and other technical specifications for encoding standard charge information in the MRF.”
5. “Require hospitals to establish and maintain a txt file and footer as specified by CMS.”
6. “Revise our enforcement process by updating our methods to assess hospital compliance, requiring hospitals to acknowledge receipt of warning notices, working with health system officials to address noncompliance issues in one or more hospitals that are part of a health system, and publicizing more information about CMS enforcement activities related to individual hospital compliance.”

These proposals come at the tail end of a string of corrective action plans (CAP) and civil/financial penalties, issued earlier this year to hospitals that CMS deemed non-compliant. As of April 2023, CMS has conducted more than 200 comprehensive reviews per month for hospital price transparency compliance and has issued more than 730 warning notices, as well as 269 CAP requests.

According to an August 2022 Patient Rights Advocate’s report, only 16% of 2,000 hospitals surveyed were found in compliance with CMS’ price transparency regulations; in addition, 51.3% of the hospitals surveyed failed some CMS’ compliancy standards, and 5.1% were deemed as totally non-compliant.

Editor’s note: To read the HealthLeaders article, click here. To read the 963-page HHS proposal, click here. To read the Patient Rights Advocate’s report, click here. To read more ACDIS coverage of price transparency requirements, click here.