fah hospital policy blog

Perspectives on health policy affecting America’s hospitals and the patients we serve.

FAH Comments on Insurer Transparency Proposed Rule

January 30, 2020 | FAH Policy Blog Team

Category: Financing, Insurance

FAH Comments on Insurer Transparency Proposed Rule

The FAH submitted comments in response to the Transparency in Coverage Proposed Rule, which would require health insurers to: publicly disclose the payment rates they have negotiated with health care providers and disclose to their enrollee’s estimated cost-sharing liability (e.g., copayments, coinsurance, and deductibles). The Proposed Rule would also allow insurers to claim credit under the medical loss ratio (MLR) methodology for “shared savings payments” made to an enrollee who selects a lower-cost provider.

Public Disclosure of Negotiated Rates

The FAH comment letter reiterates our support for HHS’ goal of transparency for patients while opposing the disclosure of negotiated rates and highlighting the legal and operational concerns with the Administration’s proposal. The comment letter argues that the Proposed Rule exceeds the Administration’s statutory authority, and raises 1st amendment/trade secret concerns. It also risks significant market disruption and unforeseen anticompetitive effects that pose significant potential harms for consumers. The letter urges CMS to engage with industry to further develop price estimator tools that provide clear, accurate, and actionable cost-sharing information tools rather than implement an unnecessary proposal to publicly release negotiated rates.

Disclosure of Cost-Sharing Information to Enrollees

The FAH comment letter expressed support for proposals that would require insurers to provide enrollees information regarding their cost-sharing liability, including the accumulated deductible and out-of-pocket amounts incurred by the enrollee to date, and any prerequisites to coverage for the item or service. 

“Shared Savings Payments” under the MLR

The FAH comment letter opposed the proposal to allow insurers to claim credit under the MLR for “shared savings payments” made to an enrollee who selects a lower-cost provider. Allowing insurers to treat payments to enrollees who obtain care from lower-cost providers as if those dollars had been spent on health care services or activities to improve the quality of care would allow insurers to spend less on their enrollees’ care without returning the premium dollars saved to all enrollees as required by the statute.

You can read the FAH’s comment letter here