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A think tank that's been working for years to make the U.S. health care system more transparent has an idea for increasing transparency: punish insurers and employer-sponsored health plans that fail to comply with federal transparency standards.
Caroline Pearson, the executive director of the Peterson Center on Healthcare, has included that recommendation in a letter commenting on federal regulators' new Transparency in Coverage draft regulations.
Officials at the U.S. Department of Labor's Employee Benefits Security Administration developed the new draft TiC regulations together with teams at the U.S. Treasury Department's Internal Revenue Service and the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services.
Pearson told federal regulators that, if they want employer plans to do a better job of posting complete sets of detailed data in a standard, well-structured format, they should push providers to send employers better data; make employers' reporting rules easier for employers to follow; and add data elements, such as claim volume figures, that would make the files more useful to employers.
The federal departments that developed the draft should also strengthen compliance efforts, Pearson said.
"Widespread noncompliance with TiC file construction and completeness severely limits the data's utility," she said.
If regulators' new regulations make the data that employers are getting and posting cleaner and less error-prone, "it is prudent that the departments go further and propose new enforcement provisions," Pearson added.
She suggested that federal regulators develop enforcement programs similar to those in use in Colorado and Indiana. Colorado, for example, has received permission from the federal government to impose penalties and fines on insurers that fail to post the required transparency files.
Katy Johnson, president of the American Benefits Council, emphasized that regulators should protect employers and their plans against enforcement efforts related to problems with getting data from other parties.
"The council encourages the departments to consider adoption of a good faith safe harbor to ensure plans that make good faith efforts are not exposed to liability," Johnson wrote.
What it means: Employers and their benefits advisors could get valuable information if other payers do a better job of posting the kind of detailed payment information required by the draft TiC regulations.
If regulators agree with the Peterson Center, employers and benefits advisors might also need more help from compliance advisors and technology services to avoid new kinds of transparency-related legal problems.
The draft Transparency in Coverage regulations: Existing federal TiC laws and regulations already require hospitals to post detailed, service-by-service, "machine-readable" price files on the web, and the existing laws and regulations already require health insurers and health plans to post detailed price and cost-sharing information.
Benefits brokers, health policy researchers and others have noticed that compliance with the transparency requirements tends to be low and that the files that are posted are often incomplete, difficult to use and difficult to combine with the transparency files from other providers or other payers.
Federal regulators hope the new draft regulations will increase compliance with the existing transparency rules and make the transparency files posted easier to use.
The comment submission deadline ended Monday. At press time, officials had recorded receiving 117 comments on the docket.
The proposed health care transparency regulations are coming out as the Labor Department's Employee Benefits Security Administration is working separately on a batch of pharmacy benefit manager transparency regulations.
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