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CMS finalizes hospital price transparency requirements; delays start date until 2021

Joseph Krause (jkrause@hallrender.com) is an attorney with Hall Render in Milwaukee, WI. Benjamin Fee (bfee@hallrender.com) is an attorney at Hall Render in Denver, CO.

Beginning January 1, 2021, hospitals throughout the country will be required to publicly disclose the prices they charge for items and services they provide, including the specific reimbursement and payment rates the hospital has with third-party payers. Both the federal government and individual states have enacted other price transparency laws over the past several years, but the new requirements represent the broadest reaching and most comprehensive mandates to date.

The new price transparency requirements were published as a final rule in the Federal Register on November 27, 2019 (final rule).[1] Despite broad opposition from the hospital industry on several aspects of the proposed price transparency rule published on July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) mostly finalized the hospital price transparency requirements as proposed, although, CMS did delay the effective date until January 1, 2021, giving hospitals just over a year to implement these requirements.

This article outlines the history of hospital price transparency efforts, the specific requirements included in the final rule, and the inevitable legal challenges brought by the hospital industry.

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