On January 1, 2019, all hospitals are required to make public a list of their standard charges. As a reminder, Section 2718(e) of the Public Health Service Act, as enacted by the Affordable Care Act, requires:
“each hospital operating within the United States” to “make public (in accordance with guidelines developed by the Secretary) a list of the hospital’s standard charges for items and services provided by the hospital, including for diagnosis-related groups established under section 1886(d)(4) of the Social Security Act.”
In the 2019 Inpatient Prospective Payment System final rule (83 Fed. Reg. 41144), CMS finalized a requirement for hospitals to publish current standard charges via the internet in a machine readable format. A hospital may publish the chargemaster or price information in any other form, so long as it is machine readable. CMS is not requiring the information to be published in a payer-specific manner and it must be updated at least annually. CMS released guidance in September clarifying that:
- The format for a hospital to make public a list of standard charges via the internet is the hospital’s choice, so long as the information represents the current standard charges.
- The requirement applies to all items and services provided by the hospital.
- Machine-readable is defined as “a digitally accessible document but more narrowly defined to include only formats that can be easily imported/read into a computer system (e.g., XML, CSV).” A PDF would not satisfy the requirement.
- A hospital is not precluded from posting quality information or price transparency information in addition to the standard charges in its chargemaster.
- Satisfaction of a state price transparency initiative does not exempt a hospital from the price transparency requirements.
In additional guidance, CMS reiterated that enforcement for failing to comply with this requirement will be addressed in future rulemaking. The agency also reiterated that subsection (d) hospitals must make public a list of standard charges for each diagnosis-related-group.
Norton Rose Fulbright professionals are available to provide additional information regarding compliance with the hospital price transparency requirements.