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Hospital, Health Coverage Disclosure Mandates Coming Soon

Nov. 14, 2019, 5:15 PM

The Trump administration is on the verge of releasing two rules that would require hospitals and health industry participants like insurers to disclose more information about their prices.

The rules could dramatically change billing in health care and the way the industry conducts transactions. The two rules will be among the most scrutinized proposals to pass through the department as both hospitals and insurers say the rules could cost them more and reveal negotiated prices they say are proprietary.

One rule on hospital pricing transparency will be final, which means it will go into effect within a few months after the publication date. The hospital industry is expected to sue to stop it. The second rule on transparency in health coverage is a proposal and will need to go through a notice-and-comment period before being finalized.

The Department of Health and Human Services is expected to come out with the two rules as early as Nov. 14. They cleared the White House Office of Management and Budget Nov. 11 and 12, the last administrative stop before a regulation can be published.

President Donald Trump signed an executive order June 26 directing the HHS to release a rule that would require hospitals to disclose prices that patients and insurers actually pay. The hospital industry protested that the disclosures would be burdensome because the negotiations with insurers are intense and complicated. Hospital executives and their attorneys have warned that the proposed rule could actually raise prices. Industry participants will be watching closely to see if the final rule walks back any of the disclosure requirements.

Trump also wants HHS to mandate insurers and health-care providers give patients information about out-of-pocket costs before they receive services. Former administration officials believe the proposed rule cleared by OMB titled “transparency in coverage” could require insurers to disclose out-of-pocket rates to patients.

To contact the reporter on this story: Shira Stein in Washington at sstein@bloomberglaw.com

To contact the editors responsible for this story: Fawn Johnson at fjohnson@bloomberglaw.com; Brent Bierman at bbierman@bloomberglaw.com