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Final Rule on Healthcare Price Transparency Released

October 30, 2020

Craig Wilson, JD, MPA
Director, Health Policy
501-526-2244
cwilson@achi.net

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On Thursday, Oct. 29, the U.S. Department of Health and Human Services, the Department of Labor, and the Department of the Treasury issued a final rule on healthcare price transparency. With an effective date of January 2022, the rule will require that almost all health insurance companies and self-insured plans disclose pricing and cost-sharing information over several years.

The requirement for publicly available, standardized data files is intended to offer opportunities for research, innovation, and price comparison tool development. In 2023, the year after the rule takes effect, insurers must make cost-sharing information available for 500 specified items and services, and in 2024, insurers must make cost-sharing information available for all items and services.

The final rule is a companion to a similar rule requiring hospitals to disclose negotiated payment rates with insurers for about 300 shoppable services. That rule is expected to go into effect in January 2020 unless legal challenges by hospitals are successful. We have written previously about federal healthcare transparency efforts, and I referenced a popular musical in a guest column for the Arkansas Democrat-Gazette discussing the new federal rule on hospital price transparency.

A number of states have been well ahead of the federal government on healthcare price transparency efforts, including Arkansas, where lawmakers enacted the Arkansas Healthcare Transparency Initiative Act in 2015. In the five years since its inception, data from the Initiative — including nearly seven years of healthcare claims and enrollment data in the Arkansas All-Payer Claims Database  — have been used to support research, healthcare system evaluation, policy development, regulatory oversight, and transparency tool development. Data from the Initiative have been valuable during the COVID-19 pandemic, enabling state officials to better understand health outcomes for those with pre-existing conditions who contract the virus.