Health Care Price Transparency 2.0: Mandating Disclosure of Costs by Providers and Insurers.
This law significantly expands healthcare price transparency, requiring hospitals, labs, imaging centers, and surgical centers to publicly disclose all standard charges, negotiated rates, and cash prices. Health insurers must provide real-time online tools for patients to check their out-of-pocket costs and must publicly release detailed monthly pricing data. The act introduces substantial financial penalties for non-compliance and ensures health plans can access all claims data from third-party administrators.
Key points
Hospitals must disclose all negotiated rates with insurers, discounted cash prices (which must be accepted as full payment from cash payers), and maximum/minimum negotiated charges in machine-readable formats.
Penalties for non-compliant hospitals are drastically increased, potentially reaching millions of dollars for persistent failure to disclose pricing information.
Health plans must offer real-time online tools showing specific patient costs (deductibles, copayments) for services, including prior authorization requirements.
Group health plans gain unrestricted access to all claims and encounter data from Pharmacy Benefit Managers (PBMs) and Third-Party Administrators (TPAs), voiding restrictive contract clauses.
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