New Rules on Transparency in Health Costs

In late October, the Departments of Health and Human Services, Labor, and Treasury published a new rule regarding transparency in health care costs.

The rule requires most group health plans to provide cost information to participants on an online self-service tool, or via paper as requested. Required disclosures include the negotiated rates or allowed amounts for covered health care items and services, estimated cost-sharing responsibility of the participant for a particular health care item or service, and the deductible and out-of-pocket maximum amounts the participant has already paid. The disclosure of cost-sharing information will be implemented over time beginning in 2023. In January 2023, cost information regarding a set of 500 items and services (as determined by the Departments) must be available. Following in January 2024, information for all covered items and services must be available. This tool must be available to current participants and their authorized representatives, but is not required to be publicly available. While self-insured plans are ultimately responsible for the availability of this information, they can delegate the responsibility to a third party, such as a third-party administrator or pharmacy benefit manager.

Additionally, plans are also required to publicly publish data on applicable rates with in-network providers, billed charges from and allowed amounts to out-of-network providers, and negotiated rates and historical prices for in-network prescription drugs. This information must be provided on a website, free of charge and publicly, beginning in January 2022.