Beginning July 1, 2022, the Departments of Health and Human Services, Labor and Treasury (the “Departments”) will begin enforcing the Transparency in Coverage Final Rule (“TiC Rule”) broadly requiring non-grandfathered health plans, including self-insured plans, to publish the price of nearly every health care service negotiated with providers. The TiC Rule continues federal efforts to promote greater health care price transparency for consumers and comes more than a year and a half after hospitals were required to comply with the analogous Hospital Price Transparency Rule.
Background
The TiC Rule requires health plans to publicly post machine-readable files disclosing: (1) negotiated rates with in-network providers; and (2) historic billed charges and allowed amounts paid to out-of-network providers. These machine-readable file requirements were applicable for plan years (in the individual market, policy years) beginning on or after January 1, 2022. However, the Departments announced via FAQ guidance that they were deferring enforcement of these requirements until July 1, 2022. Notably, the Departments have indefinitely deferred the requirement for health plans to post a third machine-readable file containing negotiated rates for prescription drugs. For additional information regarding the TiC Rule, please refer to our previous article here.
Additional Guidance
In preparation for the upcoming effective date of the TiC Rule, the Departments published FAQs regarding compliance with the machine-readable file requirements, including how plans should report rates for items or services where the negotiated rate cannot be determined in advance of the delivery of the item or service. The FAQs allow plans to report a percentage number (if applicable) or a description of the formula, variables, methodology or other information necessary to understand the arrangement in these situations.
Future Deadlines
Beginning January 1, 2023, the TiC Rule will also require plans to create a tool whereby their enrollees can receive real-time, personalized estimates of potential cost-sharing liability for 500 designated items and services. This cost sharing tool must provide the same information for all covered items and services, for plan and policy years beginning on or after January 1, 2024.
If you have specific questions about the Tic Rule Requirements, and how they may impact your organization, please contact:
- Benjamin Fee at (720) 282-2030 or bfee@hallrender.com;
- Lisa Lucido at (248) 457-7812 or llucido@hallrender.com;
- Matt Reed at (317) 429-3609 or mreed@hallrender.com; or
- Your primary Hall Render contact
Special thanks to Summer Associate, Jennifer Davis, for her assistance with this alert.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer an individual’s questions that may constitute legal advice.
