According to the Centers for Medicare and Medicaid Service (CMS), the three-step plan to require health insurers and self-insured employers to share the prices they’ve negotiated with providers for health care services has started. The first step, which began Friday, required insurers and employers to make “Machine-Readable Files” containing costs for items and services. These files include:
- In-Network Rate File: rates for all covered items and services between the plan or issuer and in-network providers.
- Allowed Amount File: allowed amounts for, and billed charges from, out-of-network providers.
The second and third steps of the plan go into effect in 2023 and 2024 respectively, according to CMS. Both steps involve the creation of internet-based price comparison tools, first to cover 500 items and services, and then to cover all items and services.
“By plan or policy years beginning on or after January 1, 2023, most group health plans and issuers of group or individual health insurance coverage are required to disclose personalized pricing information for all covered items and service to their participants, beneficiaries, and enrollees through an online consumer tool, or in paper form, upon request,” CMS said. “Cost estimates must be provided in real-time based on cost-sharing information that is accurate at the time of the request.”
One of the few exceptions to the new rules on sharing the costs of health care services is prescription drug costs, except those administered in hospitals or doctors’ offices. Insurers or self-insured employers could be fined as much as $100 a day for each violation and each affected enrollee if they fail to provide the data.
NPR contributed to this report.