The latest guidance does not apply to a requirement for transparency in pharmacy benefits and drug prices, which is scheduled to go into effect at the end of the year. (Photo: Shutterstock)
Hospitals and health systems did their best to delay the first iteration of the federal price transparency rule requiring them to disclose prices, to no avail. Health insurers, however, are having a little more luck. Last week, the Centers for Medicare & Medicaid Services announced a six-month delay in enforcement of several of the insurer price transparency law's key provisions, which is scheduled to take effect on January 1, 2022.
The law will take effect as intended, with insurers required to disclose their in-network and out-of-network rates, but enforcement will not begin until July. "On July 1, 2022, the departments intend to begin enforcing the requirement that plans and issuers publicly disclose information related to in-network rates and out-of-network allowed amounts and billed charges for plan years," CMS wrote.
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Specifically, the CMS acknowledged the time and effort required to create machine-readable files with all of the required data.
"These complex regulations set forth new responsibilities for health plans, employers, and health insurers, Annette Bechtold, SVP of regulatory and affairs and compliance for OneDigital, wrote in a blog post. "Several elements include technology, reporting, and the public posting of information. While good for creating a transparent environment, these new mandates will require additional cost, infrastructure, and information not currently available in today's marketplace. There is great concern by entities and groups that they will be unable to build these new solutions in time to meet the deadlines."
A recent poll by health care payment company Zelis found that 74% of executives are worried about meeting the transparency requirements by the original January 1 deadline. "The advanced explanation of benefit requirements are going to be a heavy lift for many insurers, considering 73% rely on paper-based processes for payments and more than half aren't sure how to get the necessary pricing data," said Matthew Albright, Chief Legislative Affairs Officer at Zelis.
The CMS also issued some advice for the requirement that plans submit information about drug costs and pharmacy information, which has not yet been granted an extension past its current deadlines, despite recent legal action taken by the pharmaceutical industry. "Until regulations or further guidance is issued, the departments strongly encourage plans and issuers to start working to ensure that they are in a position to be able to begin reporting the required information with respect to 2020 and 2021 data by Dec. 27, 2022," the CMS wrote.
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Emily Payne
Emily Payne is director, content analytics for ALM's Business & Finance Markets and former managing editor for BenefitsPRO. A Wisconsin native, she has spent the past decade writing and editing for various athletic and fitness publications. She holds an English degree and Business certificate from the University of Wisconsin.
