HHS Proposes Price Transparency Requirements for Health Plans

The Departments of Health and Human Services (HHS), the Treasury, and Labor released a new proposed rule on price transparency reporting requirements for non-grandfathered health plans and for health insurance issuers offering non-grandfathered group and individual health insurance coverage.

With the new rule, plans and issuers will need to simplify their in-network data to make it easier for beneficiaries and enrollees to find and compare rates.

Health plans and issuers currently are required to post monthly in-network rates for covered items and services, out-of-network costs, and in-network prescription drug rates.

Now, plans and issuers will need exclude information on unlikely provider-rate combinations, making in-network comparisons easier. They will also need to prepare rate information for each provider network as opposed to only for each plan or policy.

HHS is also changing requirements to increase reporting for out-of-network pricing, aiming to make more data available for users to compare rates.

HHS proposes to decrease reporting on in-network rates from monthly to quarterly to lower data storage and hosting costs, and to require plans and issuers to post a link to provider rate information in the footer of their website.

These requirements will be effective 12 months after the final rule is published in the federal register.

Contact Director of Policy Rob Nelb, MPH, at [email protected] or 202.585.0127 with questions.