The Centers for Medicare & Medicaid Services (CMS) has tightened its enforcement process for the hospital price transparency rule. Hospitals failing to submit a corrective action plan on time or within 45 days will now face an automatic civil monetary penalty. The agency will no longer issue warning notices to hospitals for failing to post a machine-readable file or shoppable services list/price estimator tool; instead, hospitals will be asked to submit a corrective action plan immediately. The move aims to increase transparency in healthcare pricing and help patients make informed decisions.
On April 27, 2023, the Centers for Medicare & Medicaid Services (CMS) announced changes to its enforcement process for the hospital price transparency rule. CMS has stated that it will now automatically impose a civil monetary penalty if hospitals fail to submit a corrective action plan (CAP) on time or fail to complete the CAP within 45 days. This change comes as part of an effort to ensure that hospitals are transparent in their pricing practices, making it easier for patients to understand the costs of medical procedures.
The hospital price transparency rule, which took effect in January 2021, requires hospitals to publish a machine-readable file containing their standard charges for all items and services provided by the hospital. A consumer-friendly list of prices for 300 “shoppable” procedures, including a hip replacement or a CT scan, must also be made available by hospitals. The shoppable services list must be shown so that patients can quickly compare costs between hospitals.
In the past, CMS has provided hospitals with a warning notice if they failed to post a machine-readable file, shoppable services list, or price estimator tool. But the agency will no longer send a warning notice under the new enforcement procedure. Instead, CMS will immediately ask the hospital to submit a CAP. The CAP must outline the steps the hospital will take to come into compliance with the rule.
If the hospital fails to complete a CAP within 45 days or submits it late, CMS will assess a civil monetary penalty. For hospitals with fewer than 30 beds, the fine might be as high as $300 per day or as little as $10 per day, depending on the number of beds. Hospitals that continue to violate the law risk further fines.
According to CMS, it will keep an eye on hospitals’ adherence to the price transparency regulation and will take the necessary enforcement measures as needed. The organization has additionally urged patients to use hospital price data to make educated healthcare decisions.
