The Trump administration is proposing updates to price transparency requirements for payers in a move regulators say will make the information more accurate and accessible.
The proposed Transparency in Coverage rule, issued late Friday by the Centers for Medicare & Medicaid Services (CMS) and the departments of Labor and the Treasury, builds on price transparency regulations instituted in President Donald Trump's first term. Those rules led to the release of a trove of pricing data from both payers and providers, but access to the information as well as usability have posed ongoing challenges.
In the new proposal, the CMS said insurers would now be required to exclude in-network data for services that a certain provider is unlikely to perform as well as require that change logs and utilization files be made available so users can identify changes and quickly recognize which services providers are actively offering.
In addition, the CMS intends to lower the reporting cadence for in-network rates and allowed amounts from monthly to each quarter, easing the reporting burden while maintaining access to key transparency data, according to an announcement from the agency.
Payers' in-network rate files would be reorganized to be listed by provider network rather than by plan, which would reduce redundancies and align the documentation with pricing data that are released by hospitals under their own regulations.
The CMS also proposed increasing the amount of data released on out-of-network costs by reorganizing how insurers should report the Allowed Amount information. This includes grouping information by insurance market, lowering the claims threshold to 11 or more and increasing the reporting period from 90 days to six months.
“Every person deserves to know what their healthcare will cost without needing a team of analysts to decode it,” said CMS Administrator Mehmet Oz, M.D., in the announcement. “This overhaul takes a giant step toward that effort. By delivering clearer, more reliable pricing information, we are empowering Americans to take control of their care and creating a more competitive and affordable health system in the process.”
The proposed rule also aims to boost access to price transparency data by requiring that insurers make the same level of detail on cost-sharing available online, in print or by telephone, which ensures that individuals who lack internet access or struggle with digital literacy can still find key information. The CMS said this change will also help align the requirements to the No Surprises Act.
"By improving clarity, accuracy, and providing better contextual information, the Departments aim to equip employers, innovators, and researchers with the information they need to strengthen negotiations, identify cost drivers, and build new tools that help consumers shop for care with confidence," the CMS said in the press release.
The agency said the rule does include any major changes to disclosures around prescription drug pricing, which will be addressed separately in the future.