Transparency in Coverage Rule

Trump Administration Announces Historic Price Transparency Requirements to Increase Competition and Lower Healthcare Costs for All Americans

(CMS press release, 11/15/19):

If finalized, the proposed Transparency in Coverage rule would require health plans to:

• Give consumers real-time, personalized access to cost-sharing information, including an estimate of their cost-sharing liability for all covered healthcare items and services, through an online tool that most group health plans and health insurance issuers would be required to make available to all of their members, and in paper form, at the consumer's request. This requirement would empower consumers to shop and compare costs between specific providers before receiving care.
• Disclose on a public website their negotiated rates for in-network providers and allowed amounts paid for out-of-network providers. Making this information available to the public is intended to drive innovation, support informed, price-conscious decision-making, and promote competition in the healthcare industry. Making this information public directly helps the consumer, but, importantly, creates new opportunities for researchers, employers, and other developers to build new tools to help consumers. 

See also the CMS fact sheet; New Rule to Make More Health Care Rates Public (Washington Post, 11/15/19). For a more detailed explanation, see this Health Affairs blog post (11/17/19).