Hospital Price Transparency Regulations
As of January 2021, the Public Health Service (PHS) Act, required each hospital operating within the United States, for each year, to establish, update, and make public a list of the hospital’s standard charges for items and services provided by the hospital. Accordingly, most institutions in the United States that are licensed as hospitals must post their standard charges prominently on a publicly available website.
Under the regulations, a hospital means an institution in any state that is licensed as a hospital or otherwise licensed facility pursuant to such state laws or is approved. For purposes of this definition, a state includes each of the several states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
The Hospital Price Transparency Regulations require that hospitals post their prices in a machine readable file and in a consumer-friendly way
Machine Readable File
A Single machine-readable digital file containing the following standard charges for all items and services provided by the hospital: gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges.
Consumer-friendly Display of Shoppable Services
A display of at least 300 “shoppable services” (or as many as the hospital provides if less than 300) that a health care consumer can schedule in advance. Must contain plain language descriptions of the services and group them with ancillary services, and provide the discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges.
Enforcement
The Hospital Price Transparency regulations became effective as of January 1, 2021 and by December 2021 the U.S. Centers for Medicare & Medicaid Services had sent out over 335 warning letters to hospitals for non-compliance. While CMS did not impose fines on non-compliant hospitals in 2021, they indicated that they will begin doing so in 2022.
Fines will be assessed on a sliding scale based on hospital size as follows:
30 or fewer beds = maximum daily penalty of $300
31 and 550 beds = maximum daily penalty of $10 per bed
> 550 beds = maximum daily penalty of $5,500
Learn how Marigold can help you maintain Hospital Price Transparency compliance.
