CMS delays enforcement of key parts of price transparency rule by 6 months

The Biden administration has delayed enforcement of key parts of a major insurer price transparency rule by six months until July 1, 2022, to give plans more time to comply.

The Centers for Medicare & Medicaid Services (CMS) announced the change in a new guidance released Friday focusing on the final price transparency rule released last October under the Trump administration. The guidance focuses on a requirement that certain health plans disclose online their in-network provider rates for covered items and services, out-of-network allowed amounts and billed charges for certain items and services.

The agency said it recognizes the “considerable time and effort required to make the machine-readable files available in the form and manner required in the [regulations].”

Even though the rule goes into effect Jan. 1, 2022, CMS will not enforce the requirement that plans publicly disclose their in-network, out-of-network amounts and billed charges for plan years until July 1.

Any plan year that begins after July 1 must post the files in the “month in which the plan year (in the individual market, policy year) begins.”

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The plan also gave a hint on the requirements plans will face when they must submit information on drug costs and pharmacy benefits. CMS will issue regulations in the near future on the reporting requirements, but it recognizes “the significant operational challenges that plans and issuers may encounter in complying with these reporting requirements by the statutory deadlines set forth in the statute.”

CMS said it will defer enforcement of the first requirement for reporting on Dec. 27, 2021, and the second deadline of reporting on June 1, 2022.

“Until regulations or further guidance is issued, the departments strongly encourage plans and issuers to start working to ensure that they are in a position to be able to begin reporting the required information with respect to 2020 and 2021 data by Dec. 27, 2022,” the guidance said.

The guidance comes as the price transparency rule was challenged in court in separate lawsuits from the U.S. Chamber of Commerce and the Pharmaceutical Care Management Association (PCMA), which represents pharmacy benefit managers.

PCMA charges in its lawsuit that the rule would confuse consumers and create a costly endeavor for insurers and PBMs. The chamber argues that the requirements could also raise costs to consumers by requiring insurers to reveal confidential and commercially sensitive information to competitors.