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- CMS Requires Health Plans to Discloses Service and Provider Pricing
The CMS announced that starting July 1, 2022, private, Medicare, Medicaid health insurance companies and self-insured employers must publicly disclose an itemized list of negotiated prices for health care services. The only excluded health services are the prices paid for prescription drugs, except those administered in hospitals or doctors’ offices.
The new rules are far broader than those that went into effect last year, requiring hospitals to post their negotiated rates for the public to see. Insurers must post the amounts paid for every in-network physician, hospital, surgery center, and nursing facility. In addition, insurers or self-insured employers could be fined as much as $100 a day for each violation for each affected enrollee if they fail to provide the data. Additionally, starting on January 1, 2023, regulations require insurers to offer online tools to help people get upfront cost estimates for about 500 so-called “shoppable” services, meaning medical care they can schedule ahead of time.