New rule to impose price transparency requirements on group health plans

McAfee & Taft
Contact

McAfee & Taft

Yesterday, the U.S. Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury (the Departments) issued new final regulations that will impose price transparency requirements on group health plans.  This is a very big deal.  This rule will require most group health plans to disclose price and cost-sharing information to participants, beneficiaries, and enrollees. The Departments are finalizing a requirement to give consumers real-time, personalized access to cost-sharing information, including an estimate of their cost-sharing liability, through an internet based self-service tool. This requirement is intended to empower consumers to shop and compare costs between specific providers before receiving care.

Through this final rule, plans will also be required to disclose on a public website their in-network negotiated rates, billed charges and allowed amounts paid for out-of-network providers, and the negotiated rate and historical net price for prescription drugs. Making this information available to the public is intended to drive innovation, support informed, price-conscious decision-making, and promote competition in the health care industry.

It appears the requirements will be phased in over time, with some requirements applying for plan years beginning in 2022 and others in 2023, with all requirements effective by plan years beginning in 2024.  The regulations are just under 600 pages – but more to come on this later.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© McAfee & Taft | Attorney Advertising

Written by:

McAfee & Taft
Contact
more
less

McAfee & Taft on:

Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
- hide
- hide

This website uses cookies to improve user experience, track anonymous site usage, store authorization tokens and permit sharing on social media networks. By continuing to browse this website you accept the use of cookies. Click here to read more about how we use cookies.