FAH supports the goal of ensuring that patients have access to clear, accurate and actionable cost-sharing information. Our members are focused on regulatory compliance efforts, regarding transparency, as discussed further below. In addition, they are engaged in the development and implementation of improved consumer price estimator tools and have extensive resources available to inform patients about various financial support programs for hospital services. This information allows patients to make better decisions about their care.
On the regulatory side, the Centers for Medicare and Medicaid Services (CMS) has issued multiple proposed and final rules intended to promote transparency, many of which are anticompetitive, overlapping and potentially conflicting, confusing and will not necessarily result in patients getting the information they want and need.
The hospital transparency final rule requires, effective January 1, 2021, disclosure of hospital and payer negotiated rates. This rule does not support the interests of consumers and is based on flawed operational assumptions and gross underestimation of the costs and feasibility of compliance with the requirements. Further, there are considerable gaps in federal guidance on the rule, creating significant compliance uncertainty.
A health insurer transparency in coverage proposed rule is pending with requirements for disclosure of payer and hospital negotiated rates and cost-sharing responsibility information to enrollees. CMS also recently finalized a rule requiring hospital reporting of median payer-specific negotiated rates for Medicare Advantage (MA) plans. In addition, the No Surprises Act enacted as part of the December 2020 omnibus package requires that patients be provided with certain cost estimates prior to a procedure. While FAH applauds this Act and supports insurer disclosure of enrollee cost-sharing responsibility information under the proposed insurer transparency rule, these additional, potentially conflicting, requirements on top of the hospital transparency rule will cause greater confusion and uncertainty.
Due to the above considerations, FAH urges CMS to work with stakeholders — consumers, providers, health plans and employers — to develop a new streamlined and coherent approach that rescinds anticompetitive and confusing transparency requirements while identifying opportunities to improve consumers’ need for access to clear, accurate and actionable cost-sharing information.
In addition, FAH urges HHS to exercise enforcement discretion regarding HHS policies requiring disclosure of hospital and payer negotiated rates. Specifically, HHS should refrain from issuing any citations or imposing any penalties while further evaluating the rule and allowing hospitals to direct their already strained resources to care for the increased volume of COVID-19 patients and distribute life-saving vaccines to health care workers and patients.
FAH Comments on CY 2022 Medicare OPPS Proposed Rule
FAH Offers Recommendations to Cabinet Secretaries for Independent Dispute Resolution in No Surprises Act