CMS extends comment period for health plan price transparency rule

• CMS will accept comments on a health plan price transparency proposed rule for two additional weeks, until Jan. 29.
• Health plans are concerned about the cost and complexities of the proposed requirements.
• Providers would be expected to lose $128 million from the increased price transparency.

The comment period for a far-reaching proposed requirement for health plans to post all rates negotiated with providers was extended by two weeks, until late January, after a large number of public responses.

The Centers for Medicare & Medicaid Services (CMS) will accept public comments until Jan. 29 on its proposed rule to require health plans to offer enrollees and others new information, including:

• Personalized out-of-pocket cost information for all services
• In-network negotiated rates paid to providers
• Amounts historically paid to out-of-network providers

The proposed rule is similar to, but separate from, a rule CMS finalized in November to require hospitals to post online information on their privately negotiated rates by the start of 2021. Hospitals and their advocacy groups are challenging that rule in federal court.

The extension of the comment period on the rule for health plans followed requests from America’s Health Insurance Plans (AHIP) and the Blue Cross and Blue Shield Association (BCBSA) for more time to respond, given the complexities involved. The health plan advocates had asked for 90 more days, but CMS granted only 15.

The delay also followed an unusually large number of submitted public comments — more than 5,400 by Jan. 2. The vast majority of the comments were from private citizens detailing their personal experiences with healthcare prices and voicing support for the price transparency proposal.

Health plan advocates were critical of both the hospital-focused and health plan-focused transparency rules, in part because they would undermine “competitive negotiations to lower patients’ and consumers’ costs and premiums.”

“Neither of these rules — together or separately — satisfies these principles,” Matt Eyles, president and CEO of AHIP, said in a written statement.

Health plan advocates highlight potential complications

A joint AHIP-BCBSA letter described the amount of data the rule would require health plans to produce as “staggering” and said the regulations would amount to “an unprecedented request of private industry to disclose publicly, with little time for health plans to adequately account for the number of complexities in complying with” the rule.

The complexities the health plan advocates are examining include:

• Treatment of accountable care organizations
• Issues related to prescription drug pricing
• Effect on the move to value-based care
• How to address quality
• Exemptions for staff-model HMOs
• Impact on overall healthcare costs

Various financial effects are projected

The health plan advocates said they are carefully studying the proposed rule’s analysis of the expected financial impact.

Effects envisioned by federal regulators include:

• $12 million in new federal subsidies for individual-market enrollees to cover costs passed on by health plans
• A $67 million reduction in cost-related rebates from health plans to enrollees
• A $128 million reduction in provider payments stemming from “lower medical costs for issuers and consumers”

Health plans’ annual compliance costs with the proposed rule are projected to range from $231 million to $286 million.

Potential unquantified effects on providers include:

• Fewer consumers facing collections as they use competitor pricing as a negotiating tool
• An overall decrease in healthcare costs assuming providers reduce prices to compete for customers
• An increase in healthcare costs if providers increase their negotiated rates to match those of competitors.