Executive Order Amplifies Transparency Mandates
On February 25, 2025, President Trump signed an executive order reinforcing the administration’s commitment to healthcare price transparency. This directive mandates the Departments of the Treasury, Labor, and Health and Human Services to enforce existing transparency regulations more stringently.
- Requiring hospitals and insurers to disclose actual prices, not estimates, for services rendered.
- Standardizing pricing information across providers to facilitate consumer comparisons.
- Updating enforcement policies to ensure compliance with transparency requirements
This order builds upon the 2019 initiative aimed at empowering patients with clear, accessible pricing information.
CMS Intensifies Enforcement Actions
In alignment with the executive order, the Centers for Medicare & Medicaid Services (CMS) has escalated its enforcement of hospital price transparency rules.
- CMS issued seven notices of monetary penalties in January and February 2025 alone, surpassing the total for all of 2024.
- The agency has streamlined its compliance process, now requiring noncompliant hospitals to submit a corrective action plan (CAP) within 45 days, with failure to do so resulting in automatic civil monetary penalties.
- CMS has increased the number of comprehensive reviews conducted monthly from 30-40 to over 200, leveraging automation to enhance efficiency.
These measures underscore CMS’s commitment to ensuring hospitals adhere to transparency regulations.
Technical Guidance and Compliance Tools
To assist hospitals in meeting transparency requirements, CMS has updated its technical implementation guide. Hospitals are now required to:
- Utilize standardized templates (CSV or JSON formats) for machine-readable files detailing standard charges.
- Include additional data elements, such as estimated allowed amounts and drug units of measurement, by January 1, 2025.
- Affirm the completeness and accuracy of disclosed pricing information.
These updates aim to enhance the accessibility and comparability of pricing data for consumers.
Addressing Compliance Challenges
Despite these efforts, compliance remains a significant issue. A report from Patient Rights Advocate found that only 21% of 2,000 reviewed hospitals fully complied with federal price transparency rules, complicating patients’ ability to access meaningful cost data.
Challenges include:
- Inconsistent data formats and incomplete postings.
- Difficulty for patients in navigating and interpreting complex pricing information.
- Limited penalties issued to noncompliant hospitals, potentially reducing the incentive to comply.
These issues highlight the need for effective solutions to support hospitals in achieving compliance.
How MCA Can Assist
At MCA, we understand the complexities of navigating hospital price transparency regulations. Our services are designed to help healthcare providers:
- Develop and implement compliant machine-readable files and consumer-friendly displays.
- Ensure data accuracy and completeness through rigorous validation processes.
- Stay informed about regulatory changes and enforcement trends.
- Enhance patient engagement by providing clear, accessible pricing information.
By partnering with MCA, hospitals can mitigate compliance risks and focus on delivering high-quality care.
For more information on how MCA can support your organization in achieving price transparency compliance, please schedule a complimentary consultation here.
