HHS Proposes Rule to Increase Transparency in Health Care Coverage

In an effort to provide increased transparency in American health care, the Departments of Labor, Health and Human Services, and the Treasury (the Departments) have released a Transparency in Coverage Proposed Rule in response to President Trump’s executive order. The proposed rule will require extensive disclosure requirements of health care price information to empower consumers to make informed decisions and ultimately promote competition in the health care market.

Below are some of the highlights the rule will require group health plans and health insurance issuers in the individual and group markets to follow:

  • Cost-Sharing Estimates. Give participants, beneficiaries, and enrollees out-of-pocket cost information for all covered health care items and services. Consumers would access this through an internet-based self-service tool or receive a paper copy upon request.
  • Release Negotiated Rates. Disclose on a public website the in-network negotiated rates and historical payments of allowed amounts paid for out-of-network providers. This information would be updated monthly and provided in machine-readable files.
  • Change MLR Program. Insurers may create plans designed to encourage consumers to enroll in lower-cost providers. If the plan results in savings, insurers may claim credit for “shared savings” payments when determining their MLR calculations.

The proposed rule also seeks comments on whether price and cost-sharing information should be required in a public application programming interface (API) and how information on health care quality could be incorporated in cost-sharing information in the private health care market. These comments are due 60 days from the proposed rule’s release.

It’s important to note that this is a proposed rule; entities are not subject to comply with these requirements just yet. The Departments state the transparency requirements would go into effect one year after the finalization of the rule, and the MLR provision would start with the 2020 MLR reporting year. Check out the fact sheet and proposed rule for more information on these transparency requirements.


The information and content contained in this blog post are for general informational purposes only, and does not, and is not intended to, constitute legal advice.

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