Transparency is a component of CMS proposed 2019 IPPS rule

The Centers for Medicare & Medicaid Services (CMS) on April 25 published its proposed inpatient prospective payment system rule (IPPS) for federal fiscal year 2019. The IPPS proposed rule contains a transparency provision requiring hospitals to make available a list of their current standard charges.

The Affordable Care Act (ACA) and the 2015 IPPS Final Rule included a requirement for all hospitals to establish, update and make public a list of standard charges for items and services provided, including for diagnosis related groups (DRG). This information is to be made available each year. CMS indicated hospitals could satisfy the ACA requirement by posting information on the internet, but they did not make that method a requirement, nor was it enforced.

In the recent proposed rule, CMS acknowledges chargemaster data are not helpful to patients for determining what they are likely to pay for a particular service or hospital stay.  However, CMS is proposing to update its guidance to require hospitals to make available a list of their current standard charges via the internet in a machine-readable format, and to update it at least annually. CMS proposes that this requirement can be met in the form of the chargemaster itself or in another format of the hospital’s choice. The is a change from the 2015 IPPS final rule which gave hospitals options for how to make standard charges available to the public.

CMS indicates it continues to be concerned with insufficient price transparency and out-of-network bills, and intends to consider other ways to improve the accessibility and usability of charge information and other transparency information.

Public comment on the 2019 IPPS proposed rule are due by June 25. Comments can be submitted electronically here.