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New HHS Transparency Rule Creates Historic Opportunities for Employers to Control Health Care Costs

October 30, 2020
by Mark Wilson

The American Health Policy Institute-supported Transparency in Coverage final rule will enable employers to utilize publicly available health care price data to reduce unnecessary spending and increase the quality and value of their health care benefits.

The final rule requires employers to have their third-party administrators publicly disclose detailed health care pricing data.  It also mandates that employers make available to health plan participants an internet-based self-service tool that provides price and personalized out-of-pocket cost information.

The cost of these disclosure requirements will likely be passed onto employers, but the historic increase in transparency, which AHPI and HR Policy supports, will enable large employers to substantially improve value-based care and better control health care spending in the long run. 

HHS included AHPI's recommendation to phase-in the disclosure requirements over three years in order to reduce compliance costs. 

The final rule requires,

  • For plan or policy years beginning on or after January 1, 2022:  Employers must make three machine-readable price data files publicly available.  One file must include the negotiated rates for all covered items and services between the plan or issuer and in-network providers.  The second file must include both historical payments to, and billed charges from, out-of-network providers.  The third file must detail the in-network negotiated rates and historical net prices for all covered prescription drugs by plan or issuer at the pharmacy location level.

  • For plan or policy years beginning on or after January 1, 2023:  Employers must make cost-sharing information available to plan participants for 500 specified items and services through an internet-based self-service tool.

  • For plan or policy years beginning on or after January 1, 2024:  Cost-sharing information must be available for all items and services.

During an HHS webinar announcing the new rule, AHPI President Mark Wilson thanked HHS for including our recommendations, saying the final rule "will go a long way towards improving health care quality and outcomes for all Americans."  

Outlook:  The fate of the final rule is uncertain.  While a Biden administration would likely keep and defend the rule, it will be challenged in court on several grounds and could be struck down there.