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- CMS Releases Final Price Transparency Regulation
On August 20, the CMS released guidance for implementing and enforcing new insurance price transparency regulations that would disclose cost-sharing information in advance of medical procedures. Prior to the regulation’s release, the CAP urged the CMS to consider the complexity of pathology practice as the agency implements rules that would require most group health plans to disclose the price and cost-sharing information to participants, beneficiaries, and enrollees.
While the CAP supports patient access to appropriate price information before receiving physician services and other medical care, the CAP is also concerned that some requirements may unintentionally delay services due to difficulties determining the cost of pathology services in advance. The CAP has had concerns over requirements that could potentially delay diagnostic tests and will continue to work with the CMS on this issue.
The new regulation requires a group health plan or a health insurance issuer offering group or individual health insurance coverage to disclose cost-sharing information upon request to participants, beneficiaries, or enrollees, including an estimate of the individual’s cost-sharing liability for covered items or services furnished by a particular provider in advance of receiving health care items and services, as well in-network negotiated provider rates, and historical out-of-network allowed amounts and billed charges from out-of-network providers to the public through machine-readable files.
To view the CMS Transparency in Coverage website.