January 24, 2022

Volume XII, Number 24

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January 24, 2022

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CMS Will Finalize Heightened Penalties, Additional Requirements Under Hospital Price Transparency Rule

On November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) announced that it will implement increased penalties for hospitals that do not comply with the Hospital Price Transparency Rule, effective January 1, 2022. CMS will also finalize several additional requirements for hospitals, including a requirement that hospitals ensure standard charge information is accessible to automated searches and direct downloads.

CMS will implement a sliding penalty scale based on the hospital’s number of beds. Hospitals with 30 or fewer beds will face a maximum daily penalty of $300, while hospitals with between 31 and 550 beds will face a maximum daily penalty of $10 per bed. Hospitals with more than 550 beds will face a maximum daily penalty of $5,500.

CMS will also require hospitals to ensure that their standard charge information is easily accessible, without barriers, including but not limited to ensuring that the information is accessible to automated searches and direct file downloads through a link posted on a publicly available website. This requirement will prohibit a single hospital from using multiple machine-readable files, using “blocking codes” or CAPTCHA, or requiring users to agree to terms and conditions or submit other information prior to access.

CMS also clarified that price estimator tools must allow healthcare consumers, at the time they use the tool, to obtain an estimate of the amount they will be obligated to pay the hospital for a shoppable service. Such estimator tools must be “tailored to individuals’ circumstances (whether an individual is paying out of pocket or using insurance) and provide real-time individualized out of pocket estimates that combine hospital standard charge information with the individual’s benefit information . . . or provide the self-pay amount.” The estimated amount must be “personalized” and reflect a single out-of-pocket dollar amount. An estimated range, by itself, would not meet the regulation’s requirements.

For more information on these proposed changes, click here.

© 2022 McDermott Will & EmeryNational Law Review, Volume XI, Number 307
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About this Author

Steven J. Schnelle, Mcdermott, healthcare lawyer
Associate

Steven Schnelle focuses his practice on regulatory and transactional matters involving health care providers and suppliers, as well as pharmaceutical firms and medical device manufacturers.

Steven provides counsel on a variety of issues involving the Centers for Medicare and Medicaid Services (CMS), the HHS Office of Inspector General (OIG), the Department of Justice (DOJ), as well as state and local government agencies. He advises private equity firms, investment banks, commercial lenders, and health care and life science companies on health care regulatory issues relating to...

212 547 5403
Emily J. Cook, McDermott Will Emery Law Firm, Health Care Attorney
Partner

Emily J. Cook is an associate in the law firm of McDermott Will & Emery LLP and is based in the Firm’s Los Angeles office.  She focuses her practice on Medicare provider certification, reimbursement and regulatory compliance.

310-284-6113
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