In the 118th Congress, the US House of Representatives is keenly interested in price transparency in healthcare. Three House committees—Energy and Commerce, Ways and Means and Education and the Workforce—each approved legislation that would advance price transparency objectives. Generally, these bills seek to codify (and in some respects, modify) the requirements around hospital and health plan price transparency as previously implemented by the Centers for Medicare & Medicaid Services (CMS).
While there are many similarities in the three bills, the committees and House leadership will need to negotiate certain key differences before a bill is brought to the House floor for a vote. For hospital price transparency, these issues include what information about enforcement actions against hospitals is made public, where information about enforcement actions is posted and maximum penalties for noncompliance. For health plan price transparency, these include any exemptions or limitations on compliance, frequency of required updates, the definition of participating provider and effective dates.
The bills also include key differences from current regulations. Both the Energy and Commerce and Ways and Means Committee bills would eliminate deemed compliance with consumer-friendly file requirements if a hospital maintains a price estimator tool. The bills also include penalties for a hospital’s “persistent” noncompliance with the requirements.
This +Insight compares the hospital and health plan transparency provisions of these primary pieces of legislation and compares them with current regulations. These bills also include provisions related to the role of pharmacy benefit managers, common ownership and integration and certain site neutrality requirements, which are not discussed in this article.
Key Takeaways
