Summary
A potential health package that could be advanced with the fiscal year 2024 spending bill due January 19 may include legislative proposals to improve price transparency. In this memo, we present a comparison of legislative proposals that would codify and improve the 2019 Hospital Price Transparency rule (84 FR 65524) and the 2020 Transparency in Coverage rule (85 FR 72158):
- Lower Costs, More Transparency (LCMT) Act (R. 5378), passed by the House on December 11, 2023 by a 320-71 vote; and
- Health Care PRICE Transparency Act 2.0 ( 3548), introduced by Senate Health, Education, Labor and Pensions Committee Chair Bernie Sanders (I-VT) and Sen. Mike Braun (R-IN) on December 11, 2023.
Both bills also include proposals to require that contracts between a group health plan and any other entity (including health care providers, pharmacy benefit managers, and others) allow the responsible plan access to claims and encounter information and data. Sec. 401 of the LCMT Act requires entities to allow the “responsible plan fiduciary” to audit or review all de-identified claims and encounter information and data. Sec. 7 of Health Care PRICE Transparency Act 2.0 requires entities to allow the “responsible group health plan” greater access to health data – specifically, all claims and encounter information, and any documentation supporting claims documents, such as medical records and policy documents. Both bills propose a $10,000 per day penalty for noncompliance.
Unlike the LCMT Act, Health Care PRICE Transparency Act 2.0 does not include transparency proposals for pharmacy benefit managers.