FAQ on federal insurance price transparency regulations released

A federal compilation of frequently asked questions about transparency in coverage regulations set to go into effect later this year was released April 19. 

Last year, CMS said it was delaying enforcement of the insurance price transparency rule until July 1, 2022. The rule requires insurers and health plans to disclose in-network provider rates for covered items and services, out-of-network allowed amounts and billed charges for all covered items and services, and negotiated rates and historical net prices for covered prescription drugs. The rates are supposed to be presented in separate machine-readable files. 

The FAQ was prepared jointly by HHS and the Labor and Treasury departments. 

In the FAQ, the departments said an enforcement safe harbor will be provided when plans using alternative reimbursement arrangements cannot accurately derive a specific dollar amount until after services are rendered. In these instances, plans can instead list the formula, variables, methodology or other information about how the rate would be derived. 

For contractual arrangements where a plan agrees to pay an in-network provider a percentage of the billed charges and is not able to assign a dollar amount until a bill is generated, the plans may instead report the percentage number, according to the FAQ. 

Read the full FAQ here.

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