Summary
The House and Senate are both in recess until after Labor Day. During this Congressional break, we are taking the opportunity to provide in-depth analysis of policies under consideration for a potential lame duck package, which will culminate with the release of the Impact Health Policy Partners Lame Duck and Election Preview memo in September. This week, we are highlighting health care transparency policies under consideration.
Price Transparency
In the divided Congress, members of both parties and chambers have focused on building upon hospital and health plan price transparency rules promulgated by the Trump Administration by strengthening transparency and accountability requirements. In December 2023, the House passed the Lower Costs, More Transparency (LCMT) Act (H.R. 5378) by a bipartisan vote (320-71). Also, in December 2023, Sens. Mike Braun (R-IN) and Chairman of the Senate Committee on Health, Education, Labor, and Pensions (HELP) Bernie Sanders (I-VT) introduced the Health Care PRICE Transparency Act 2.0 (S. 3548) – a bipartisan bill that represents the Senate’s version of the LCMT Act. Though S. 3548 has not been marked up, it continues to garner new cosponsors – 12 total, including four members since June. The continued momentum for price transparency reforms bodes well for the inclusion of a version of these bills in a potential lame duck package.
In this series of charts, we compare the LCMT Act, Health Care PRICE Transparency Act 2.0, and current regulations. Key takeaways:
- Provider Price Transparency: Both bills propose to codify key provisions of the Hospital Price Transparency Rule – specifically, requirements for hospitals to post standard charges in machine-readable files and consumer-friendly internet-based price estimator tools. Standard charges are gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges. In addition, both bills propose changes to address concerns with reporting requirements; increase compliance with the rule; and broaden price transparency to clinical diagnostic laboratories, ambulatory surgical centers, and imaging centers. Regarding monitoring and enforcement, the Health Care PRICE Transparency Act 2.0 proposes a more rigorous approach – requiring a compliance review at least once every year (compared to every three years in the LCMT Act), requiring an attestation from senior officials at hospitals, and prohibiting the HHS Secretary from granting any waivers to penalties. In contrast, the LCMT Act allows the Secretary to waive or reduce penalties for hospitals and ambulatory surgical centers.
- Health Plan Price Transparency: Both bills propose to codify key provisions of the Transparency in Coverage Rule – specifically, requirements for group health plans and issuers of group or individual health insurance to disclose pricing information in (1) machine-readable files containing in-network rates for covered items and services and allowed amounts for, and billed charges from, out-of-network providers; and (2) an internet-based price comparison tool (self-service tool) and in paper form, upon request. Both bills propose additional disclosures. Notably, Health Care PRICE Transparency Act 2.0 includes a provision requiring plans and issuers to hold individuals harmless for the balance if the amount ultimately billed or charged to the individual exceeds the cost-sharing amount generated by the self-service tool.
Ownership Transparency
As for ownership transparency, there is bipartisan support for incremental changes that could be included in a potential lame duck health package. LCMT Act includes a provisions requiring a unique national provider identifier (NPI) for hospital-owned outpatient departments when filing a hospital claim under Medicare, which would reveal the specific location where a patient received care. As explained by experts at Georgetown University’s Center on Health Insurance Reforms, the unique NPI information could facilitate future reforms on site neutrality. They note that the proposal in the LCMT Act does not apply to claims with private insurers. The Senate HELP Committee passed the Bipartisan Primary Care and Health Workforce Act (S. 2840), which would extend the unique NPI requirement to private insurers.
The House Energy and Commerce unanimously passed the PATIENT Act of 2023 (H.R. 3561) in May 2023, but it was excluded from the House-passed LCMT Act. The bill includes a provision on mandatory reporting on certain health-related ownership, including private equity companies, with enforcement authority to impose penalties up to $5 million per violation. House Ways and Means Ranking Member Richard Neal (D-MA) opposed the LCMT Act for its lack of ownership transparency that would work to address and identify PE control in health care. Whether the proposal could be in play during the lame duck session remains to be seen.