Source: Healthcare Finance News
The Centers for Medicare and Medicaid Services is proposing updates to 2020 Transparency in Coverage rules for greater price transparency and easier access for consumers.
The proposed rule was released last week in partnership with the Department of Labor and the Department of the Treasury.
The 2020 Transparency in Coverage rules, released under the first Trump administration, had the goal of making healthcare pricing more transparent. However, CMS said the data has been difficult to access due to oversized files, duplicative data and information that could not be easily compared across the health insurance landscape.
The new proposal aims to simplify how data is organized, eliminating unnecessary information and making consumer-facing cost tools more accessible, CMS said.
The departments seek feedback from stakeholders during a 60-day comment period that ends on Feb. 21, 2026.
WHY THIS MATTERS
The changes allow more organizations, including those with fewer technical resources, to analyze pricing data, build consumer-friendly tools and drive competition across the healthcare industry, CMS said.
The proposed rule strengthens requirements for plans and insurers to provide price comparison tools by aligning them with consumer protections established under the No Surprises Act.
Under the proposal, group health plans and insurers would be required to provide the same cost-sharing information whether viewed online, in print or provided by telephone upon request. This modernization would ensure that transparency is not limited by internet access or digital literacy, CMS said.
Updated disclosures will take into account new federal protections against balance billing under the No Surprises Act.
The proposed rules do not include major changes to prescription drug disclosure requirements. The departments intend to address this separately, CMS said.
In line with Executive Order 14221 on healthcare pricing, which was released in February, the proposed rule includes:
- Requiring plans and issuers to exclude from the In-network Rate Files certain data for services providers would be unlikely to perform.
- Reorganizing In-network Rate Files by provider network rather than by plan, cutting redundancy and aligning with how most hospitals report data under Hospital Price Transparency requirements.
- Requiring Change-log and Utilization Files so users can easily identify what has changed from one In-network Rate File to the next.
- Reducing reporting cadence for In-network Rate and Allowed Amount Files from monthly to quarterly to reduce burden.
- Increasing the amount of out-of-network pricing information reported by reorganizing Allowed Amount files by health insurance market type, reducing the claims threshold to 11 or more claims and increasing the reporting period from 90 days to 6 months and the lookback period of data from 180 days to 9 months.
THE LARGER TREND
The 2020 Transparency in Coverage rule mandated public disclosure of negotiated rates and allowed amounts in machine readable files.
In comments made after the release of the 2020 proposal, AHIP, which represents health insurance plans, said the rule failed to advance consumer goals and overstepped statutory authority.
The proposal forced disclosure of privately and competitively negotiated rates and did not provide information that was helpful to consumers, AHIP said.
ON THE RECORD
“Americans have a right to know what healthcare costs before they pay for it,” said Health and Human Services Secretary Robert F. Kennedy, Jr. “This proposal delivers real transparency by turning hidden pricing into clear, usable information—so families can make informed decisions and hold the system accountable. It fulfills President Trump’s commitment to put patients, not special interests, first.”
