CMS Tightens Hospital Price Transparency Enforcement Measures

On April 26, the Centers for Medicare and Medicaid Services (CMS) strengthened its enforcement of the hospital price transparency rule by implementing three new enforcement measures. These include:

• Shorter CAP compliance deadlines: CMS will require hospitals that are in violation of hospital price transparency requirements to comply with all terms of a corrective action plan (CAP) within 90 days of CMS requesting the CAP. Hospitals were previously allowed to propose a date by which they expected to be in full compliance of CAP terms. Hospitals will still be required to submit a CAP within 45 days from when CMS issues a request.

• Automatic CMPs: CMS will now impose automatic civil monetary penalties (CMPs) on hospitals that do not comply with the 45-day CAP submission deadline and the 90-day CAP compliance deadline. If a hospital meets either the CAP submission or CAP compliance deadline but not both, CMS will review the hospital’s files and determine whether the hospital has failed to correct any infractions CMS identified in its CAP request. Should any violations be found, CMS will impose an automatic CMP.

• Removal of non-compliance warning notices: CMS will no longer issue warning notices to hospitals if they are found to be out of compliance with price transparency requirements. CMS will now immediately request that the hospital submit a CAP.

Since announcing the hospital pricing transparency requirement, CMS has issued 730 warning notices and 269 CAP requests. Despite its increasing efforts, many studies have shown that very few hospitals are complying with the rule.

When CMS Administrator Brooks-Le Sure testified before the House Energy and Commerce committee recently, she said these steps and greater price transparency combined with the agency’s initiative on facility ownership transparency will increase competition and improve the consumer experience.