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This final rule would implement portions of Executive Order 13877 ("Improving Price and Quality Transparency in American Healthcare to Put Patients First", June 24, 2019), which provides that the Secretaries of Health and Human Services, the Treasury, and Labor will facilitate access to information about expected health care costs for patients before they receive care.

Statement of Need:

Despite the growing number of initiatives and the growing consumer demand for, and awareness of, the need for pricing information, there continues to be a gap in easily accessible information for consumers to use to shop for health care items and services.  This final rule implements new requirements aimed at addressing this gap that are a critical part of the Administration’s overall strategy for reforming health care markets by promoting transparency and competition, creating choice in the health care industry, and enabling consumers to make informed choices about their health care.

Summary of the Legal Basis:

This rule was issued by the Department of Health and Human Services, the Department of Treasury, and the Department of Labor to address multiple sections of the Patient Protection and Affordable Care Act (Public Law 111148) and the Health Care and Education Reconciliation Act of 2010 (Public Law 111152), which amended and revised several provisions of the Patient Protection and Affordable Care Act.

Alternatives:

In developing the policies for this final rule, the Departments considered several alternatives related to the following:

• Requirement for disclosure of cost-sharing information to participants, beneficiaries, and enrollees through an internet-based self-service tool.
• Limiting cost-sharing disclosures to certain covered items and services and certain types of group health plans and health insurance issuers.
• Data elements that are required to be used in the calculation of cost-sharing liability through the internet-based self-service tool.
• Requirement to make available machine-readable files of in-network rates, historical data for out-of-network allowed amount payments made to out-of-network providers, and prescription drug pricing information on a public website.
• Frequency of updates to machine readable files.
• File format requirements.

Requiring the disclosure of pricing information through an application programming interface in lieu of an internet-based self-service tool and machine-readable files.

Anticipated Costs and Benefits:

This rule is economically significant.

Risks:

Although we recognize the risks of publicizing negotiated rates and associated pricing information, the Departments have concluded that providing increased price transparency and making this information available to the public will serve the public’s long-term interests in facilitating a consumer-oriented, information-driven, more competitive health care market.