Trump Administration Overhauls Hospital and Insurer Price-Transparency Rules

The Department of Health and Human Services (HHS), together with the Labor and Treasury Departments, issued a final rule that tightens the “Transparency in Coverage” (TiC) requirements for health insurers and updates the hospital price-transparency standards first enacted in early 2021. The amendments standardize machine-readable files, require insurers to certify accuracy, and make pricing data available by phone, online and on paper. Out-of-network reporting thresholds were lowered from 20 to 11 claims, and reporting frequency shifted from monthly to quarterly. A separate blueprint for a prescription-drug price schema is slated for publication by May 2025.

HealthCareDive

The original hospital rule, effective at the start of 2021, saw slow compliance; a Patient Rights Advocate report found 49.4 percent of surveyed hospitals fully complying. Officials said oversized, duplicative files limited usability, prompting the new rule’s focus on smaller, comparable data sets. Earlier TiC rules, in effect since 2022, required insurers to post negotiated rates but produced “gargantuan” files that even experts found hard to navigate.

The Hill

HHS Secretary Robert F. Kennedy Jr. said the rule will cut file sizes by roughly 70 percent, improving information for patients, lawyers and researchers. CMS Administrator Dr. Mehmet Oz framed the changes as a way for people to know what their insurance will cover before receiving care. James Gelfand, president and CEO of the ERISA Industry Committee, noted the rule should help employers spot price differences and negotiate lower costs. Elizabeth Mitchell, CEO of the Purchaser Business Group on Health, called the update a “significant difference” for addressing commercial-market affordability.

The Hill

• 49.4 % of hospitals were fully compliant with the 2021 rule (Patient Rights Advocate).

The Hill

• File-size reduction target: 70 % (Kennedy Jr.).

The Hill

• Net annual savings projected: almost $175 million for plans and issuers (regulators).

HealthCareDive

• One-time compliance costs estimated at nearly $400 million (economic analysis).

HealthCareDive

• Out-of-network claim threshold lowered from 20 to 11 claims; reporting moved to quarterly.

HealthCareDive

• “Simply put, you basically need supercomputer to process the data, which has limited who can work with the data,” — Peter Nelson

The Hill

• “The first round of price data opened the books. This rule makes the data usable by a general audience,” — James Gelfand, the president and CEO of the ERISA Industry Committee

HealthCareDive