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Transparency in Coverage Final Rule

On October 29, 2020, the US Department of Health and Human Services (HHS), along with the US Departments of Labor and the Treasury, finalized the rule Transparency in Coverage. This rule stems from President Trump’s Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First. The final rule puts forth requirements for group health plans and issuers on the individual and group markets to disclose cost-sharing information, in-network provider negotiated rates, historical out-of-network allowed amounts, and drug pricing information. This rule does not apply to grandfathered health plans, excepted benefits plans, healthcare sharing ministries or short-term limited duration insurance plans. A similar rule requiring hospitals to publish price information was finalized in 2019 and is set to take effect January 1, 2021, although it remains subject to ongoing litigation.

Access the PDF here.

© 2022 McDermott Will & EmeryNational Law Review, Volume X, Number 308
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McDermott + Consulting, McDermott Law Firm

McDermott+Consulting serves health industry clients with one-stop lobbying services, data analytics and modeling, and policy advice.

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