New CMS Transparency Rule Takes Effect: Enhanced Health Care Pricing Information for Consumers as of July 1, 2022

Implementation of the CMS Transparency in Coverage Rule as of July 1, 2022

The Trump-era initiative released by the Centers for Medicare Medicd Services CMS on October 29, 2020, became effective on July 1, 2022 after an additional six-month grace period to facilitate compliance from insurance providers. This rule enhance consumer healthcare understanding and control costs through empowering individuals with access to health care pricing information.

From this date forward, the Transparency in Coverage Final Rule TiC Final Rule requires health insurers to provide publicly avlable data via -readable files:

1. Negotiated rates with participating medical facilities;

2. Historical charges and payments by out-of-network providers for covered services;

These disclosure requirements were applicable starting January 1, 2022 for plan years beginning on or after that date. However, the US Department of Health and Services HHS, Labor, and Treasury decided to indefinitely postpone enforcement of the -readable file requirement for drug pricing due to ongoing evaluation of its appropriateness.

Further requirements will be implemented from January 1, 2023:

1. A user-frily tool that enables enrollees to estimate potential cost-sharing expenses for 500 common services in real-time;

2. By January 1, 2024, this information must ext to cover all covered items and services.

Non-compliant insurers may face dly fines up to $100 per violation and per individual affected; exceptions are limited.

To receive further information:

Isabelle Bibet-Kalinyak: +973.403.3131 [email protected]

Lani M. Dornfeld, CHPC: +973.403.3136 [email protected]

James Ko: +973.403.3147 [email protected]

*This is inted for informational purposes only and does not constitute legal advice. For specific guidance, please contact the above mentioned attorneys.

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*This text aligns with practices related to healthcare law.

*Additional information provided by: Isabelle Bibet-Kalinyak, Lani M. Dornfeld
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