Health Benefits

ACA Updates and More

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This page provides updates on provisions contained in the Affordable Care Act and other information about laws, regulations and more.

Federal Government Releases Hospital Price Transparency Rule

Updated 1/14/20

A new federal rule requires hospitals operating in the U.S. to publish their prices for items and services on their websites, effective Jan. 1, 2021. According to the rule, these requirements will promote price transparency in healthcare and public access to hospital standard charges. The rule requires each hospital to establish and make public annually a list of its standard charges for items and services by location.

Requirement for machine-readable information

  • Hospitals must disclose a single digital file in a machine-readable format on a publicly available website that is digitally searchable. The file must include all standard charges (including gross charges, discounted cash prices, payer-specific negotiated charges with the name of the third-party payer and plan, and de-identified minimum and maximum negotiation charges) and any hospital code used for accounting or billing[1] for all items and services at a particular location. The file must be updated at least annually.

Requirement for displaying ‘shoppable’ services in a consumer-friendly manner

  • Hospitals must disclose, in a consumer-friendly manner, all standard charges (as listed above) for at least 300 “shoppable” services (and corresponding ancillary services, as applicable). “Shoppable” service refers to a service that can be scheduled by a consumer in advance.
     
  • Hospitals will comply with the requirements regarding shoppable services by maintaining an internet-based price estimator tool, providing estimates for at least 300 shoppable services identified by federal health officials, according to the Centers for Medicare & Medicaid Services. A hospital must include an easy-to-understand description of each shoppable service and indicate when it does not provide one or more of the services.

Hospital organizations filed lawsuit

In early December, various organizations representing hospitals and a couple of health systems filed a lawsuit arguing, among other things, that the U.S. Department of Health and Human Services lacks statutory authority to require and enforce the provision mandating public disclosure of individually negotiated rates between commercial health insurers and hospitals. They also argue that the rule violates the First Amendment by compelling public disclosure of individual rates negotiated between hospitals and insurers.
 
[1] Including but not limited to, the Current Procedural Terminology (CPT) code, the Healthcare Common Procedure Coding System (HCPCS) code, the Diagnosis Related Group (DRG), the National Drug Code (NDS), or other common payer identifier.

PCORI Fee Extended for 10 Years

Updated 1/14/20
The Patient-Centered Outcomes Research Institute (PCORI) fee has been extended 10 years through 2029.

PCORI will continue to use these fees to fund research to compare different medical treatments and interventions to determine what treatments are most effective with the help of clinicians, purchasers, policymakers and patients. The non-profit organization’s mission is to help doctors and patients make evidence-based healthcare decisions.

Before the extension, the fee expired with policy or plan years ending Sept. 30, 2019, (with payment due July 31, 2020). Insurers of fully insured plans and sponsors of self-funded plans ending between Oct. 1, 2018, and Sept. 30, 2019, were assessed a fee of $2.45 per average number of covered lives.

We will provide more information about the fee as it becomes available.
For more information, visit our Regulatory Resources site.