Hospital Price Transparency requirements go into effect January 1, 2021. The Centers for Medicare and Medicaid Services (CMS) plans to audit a sample of hospitals for compliance starting in January, in addition to investigating complaints that are submitted to CMS and reviewing analyses of non-compliance, and hospitals may face civil monetary penalties for noncompliance.
Is your institution prepared to comply with the requirements of the Hospital Price Transparency Final Rule? Effective January 1, 2021, each hospital operating in the United States is required to provide publicly accessible standard charge information online about the items and services they provide in 2 ways:
- Comprehensive machine-readable file with all items and services
- Display of 300 shoppable services in a consumer-friendly format
In the final rule, CMS outlined a monitoring and enforcement plan to ensure compliance with the requirements. CMS finalized a policy that CMS monitoring activities may include, but would not be limited to, the following, as appropriate:
- Evaluation of complaints made by individuals or entities to CMS
- Review of individuals’ or entities’ analysis of noncompliance
- Audit of hospital websites
If CMS concludes a hospital is noncompliant with one or more of the requirements to make public standard charges, CMS may take any of the following actions, which generally, but not necessarily, will occur in the following order:
- Provide a written warning notice to the hospital of the specific violation(s)
- Request a Corrective Action Plan (CAP) if noncompliance constitutes a material violation of one or more requirements
- Impose a civil monetary penalty not in excess of $300 per day and publicize the penalty on a CMS website if the hospital fails to respond to CMS request to submit a CAP or comply with the requirements of a CAP
See 45 CFR part 180 Subpart C- Monitoring and Penalties for Noncompliance.
Visit the Hospital Price Transparency website for additional information and resources to help hospitals prepare for compliance, including: