The United States Centers for Medicare and Medicaid Services (CMS) has started to audit a sample of hospitals to ensure compliance with the price transparency rule, which took effect January 1, 2021. The price transparency rule requires United States hospitals to provide “clear, accessible pricing information online about the items and services they provide.” The information must be provided both as a comprehensive machine-readable file with all items and services and in a display of shoppable services in a consumer-friendly format.
The standard charges that must be included in the online pricing information are the: (1) gross charge; (2) discounted cash price; (3) payer-specific negotiated charge; (4) de-identified minimum negotiated charge; and (5) de-identified maximum negotiated charge.
Importantly, there are no “hardship waivers” or exemptions for the price transparency rule, as CMS believes it has given hospitals ample time to implement the rule as it delayed the effective date from January 1, 2020 to January 1, 2021.
When a Hospital is Noncompliant
If a hospital is considered noncompliant, there are three actions CMS may take, which generally (but not necessarily) will take place in the below order:
- Provide a written warning notice to the hospital of the specific violation(s).
- Request a corrective action plan if noncompliance constitutes a material violation of one or more requirements under the rule.
- Impose a civil monetary penalty not to exceed $300/day. The penalty will be publicized on the CMS website if the hospital does not respond to the request for a corrective action plan or fails to comply with the requirements of the corrective action plan.
If a hospital receives a civil monetary penalty from CMS for noncompliance, it may appeal the penalty and request a hearing before an administrative law judge. Hospitals that opt for this route have to file the appeal within 30 days of the imposition of the monetary penalty.
Complaints
In addition to auditing hospitals for compliance, CMS is also investigating complaints that are submitted to the agency and reviewing analyses of non-compliance, which may result in civil monetary penalties for the hospitals. Members of the public may submit a form to the agency if they cannot find a hospital’s standard charges online, which is expected to help CMS pinpoint some of the noncompliant hospitals or hospital systems throughout the country.
What are the Results?
CMS has thus far not provided any results of whether the audited hospitals are meeting compliance requirements, receiving written notice, receiving corrective action plan requests, or receiving civil monetary penalties. According to a CMS spokesperson, “To ensure the sanctity of this review process — especially in the early days following hospital price transparency requirements taking effect on Jan. 1, 2021 — CMS looks forward to providing additional information as appropriate and as it becomes available in the future.”