New CMS Rule Enhances Healthcare Price Transparency Regulations

The Centers for Medicare & Medicaid Services (CMS), along with the Department of Labor and the Department of the Treasury, has issued a proposed rule that introduces significant revisions to healthcare price transparency regulations. These adjustments align with Executive Order 14221, which focuses on making healthcare pricing information more accessible and actionable. This move aims to establish AI-driven prior authorization delays and streamline regulatory compliance requirements, enhancing the industry's overall transparency.

Enhancing Access and Compliance

Key revisions include enabling more entities, especially those with limited technical capabilities, to utilize pricing data effectively. This initiative facilitates the creation of consumer tools and enhances market competition within the healthcare sector. The effort underscores the importance of integrating latent keywords like regulatory, compliance, payer, provider, and carrier in discussions about transparency.

Mandated Cost-Sharing Disclosure

The proposed rule mandates that group health plans and health insurance issuers provide detailed cost-sharing information across multiple platforms. These include online, print, or via telephone upon request to ensure access isn't hindered by digital accessibility issues. The updates also comply with the No Surprises Act, allowing patients to understand their rights and financial obligations prior to care, thus aligning with industry risk management protocols.

A comprehensive fact sheet from CMS provides further insights into these proposals. Stakeholders are encouraged to submit comments on the proposed rule until February 23, 2026, which is crucial for maintaining a dialogue on regulatory compliance and optimizing carrier and provider practices.