Feds Propose Tougher Price Transparency Rules for Benefits
Federal agencies have proposed amended rules for price transparency in employee benefits and compensation. The new framework emphasizes real-time, digital-first reporting, signaling a regulatory shift from static annual disclosures to dynamic, on-demand transparency for employees and regulators.
These proposed amendments build on the Transparency in Coverage final rules from 2020 and the Consolidated Appropriations Act of 2021, which includes the No Surprises Act. Those regulations mandated the creation of machine-readable files for in-network provider rates, out-of-network allowed amounts, and prescription drug pricing, which became applicable in July 2022. The new rules, proposed jointly by the IRS, the Employee Benefits Security Administration (EBSA), and Health and Human Services (HHS), aim to standardize and improve the usability of the currently disclosed data. Regulators found the initial machine-readable files were often too large, lacked context, and were difficult for researchers and developers to analyze effectively. Key changes include shifting from monthly to quarterly updates for in-network and out-of-network files to reduce the burden on plans and issuers. The proposals also require a direct "Price Transparency" or "Transparency in Coverage" link on the homepage of a plan's website to improve accessibility. To make the data more meaningful, the proposed regulations would require payers to disclose in-network rates by provider network rather than by individual plan. They also aim to increase the amount of out-of-network pricing information by lowering the minimum number of claims required for disclosure from 20 to 11. The amendments also seek to align with the No Surprises Act by requiring that cost-sharing information be available over the phone, in addition to the existing online self-service tools and paper-based options. This creates a unified requirement for consumer access to pricing information. If finalized, the new rules would generally take effect 12 months after their publication in the Federal Register. However, specific amendments related to the internet-based self-service tool would apply to plan years beginning on or after January 1, 2027. This regulatory push is creating a new market for tools that can ingest and analyze the mandated pricing data, offering employers comparative insights into provider network costs by location, service, and specialty. The availability of this data shifts significant fiduciary responsibility to employers, who are now expected to use it to make more prudent, cost-effective decisions about their health plans.
