On January 1, 2021, the Centers for Medicare and Medicaid Services (CMS) implemented a hospital price transparency regulation that required hospitals to publicly post their prices. Under the rule, hospitals in the United States are required 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 transparency information are the gross charge; the discounted cash price; payer-specific negotiated charges; the de-identified minimum negotiated charge; and the de-identified maximum negotiated charge.
However, according to a tally from CMS, only 335 warning notices have been sent out as of December 2021 and no fines have been levied. The written warning notices state which specific issue the non-compliant hospital needs to address.
In addition, CMS has issued 98 requests for corrective action plans to non-compliant hospitals that had previously received a warning but had not yet corrected the material violation deficiencies. Of those 98 requests sent, only 23 hospitals have addressed their citations and received a case closure notice from CMS.
CMS says it has not yet issued any civil monetary penalties to hospitals because each hospital that has received notice of their non-compliance has either come under compliance or is in the process of doing so. However, CMS says that any hospitals that do receive a civil monetary penalty in the future will have their name published on the Hospital Price Transparency section of its website.
CMS also noted that while noncompliance used to max out at a cost of $300 per day (up to $110,000 per year), in 2022, the maximum penalty has increased to $5,500 per day, for more than $2 million per year, based on the Outpatient Prospective Payment System (OPPS) rule for 2022. Under the 2022 OPPS rule, CMS will levy a minimum civil monetary penalty of $300 per day for hospitals with 30 or fewer beds. For hospitals with more than 30 beds, they will be charged $10 per bed per day, capped at $5,500 daily.
Compliance with the transparency rule is all over the map, with many different researchers and analysts finding inconsistencies in compliance. Hospitals claim the language in the rule is confusing or imprecise, preventing them from fully complying, despite their good faith efforts. Last year, Congress even expressed concern over the lack of compliance, sending a letter to Health and Human Services Secretary Xavier Becerra, requesting audits of hospitals and revisiting enforcement tools (including increasing the civil monetary penalty for non-compliance, which was done in 2022 as noted above).
It will be interesting to watch as 2022 progresses, whether CMS starts to fine hospitals for non-compliance with the transparency rule and its requirements.