June 26, 2019

Executive Order on Healthcare Price Transparency

Holland & Knight Healthcare Blog
Miranda A. Franco

On June 24, 2019, President Trump signed a long-awaited executive order that he said would "fundamentally" change the healthcare market. The order builds upon current regulations that require hospitals to make available a list of their current standard charges via the Internet in a machine-readable format and to update this information at least annually.

Notably, the order does not spell out specific actions. Instead, it is a directive to draft new rules or guidance. Further details will emerge as the proposals are put forth.

The impact of the order will largely depend on how the agencies involved carry out President Trump's mandate. The first indication of how far agencies may take this will likely come in the forthcoming Outpatient Prospective Payment System (OPPS) proposed rule where it is expected we will see price-disclosure requirements.

Notable takeaways are as follows:

  1. Requires hospitals to disclose information about negotiated rates for "shoppable" services. The order directs the Secretary of Health and Human Services (HHS) to propose a regulation within 60 days, "to require hospitals to publicly post standard charge information, including charges and information based on negotiated rates and for common or shoppable items and services, in an easy-to-understand, consumer-friendly, and machine-readable format using consensus-based data standards that will meaningfully inform patients’ decision making and allow patients to compare prices across hospitals."
  2. Provide patients access to information about out-of-pocket costs before treatment. The order directs the HHS, Treasury, and Labor Departments to issue an advance notice of proposed rulemaking within 90 days. The rule would solicit comment on a proposal to require healthcare providers, health insurers, and self-insured group health plans to provide or facilitate access to out-of-pocket costs for items or services to patients before they receive care.
  3. Address Surprise Billing. The order requires HHS to determine within 180 days further regulatory steps that may be taken to address surprise billing while looking into other barriers that impede healthcare price and quality transparency for patients.
  4. Development of a Health Quality Roadmap. The order directs the Secretaries of HHS, Defense and Veterans Affairs (VA) to develop a Health Quality Roadmap within 180 days that aims to align and improve reporting on data and quality measures across Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), the Health Insurance Marketplace, the Military Health System, and the Veterans Affairs Health System.
  5. Tells HHS, other agencies to store de-identified claims data for research. Agencies have 180 days to implement a system that will increase researchers' and providers' access to deidentified claims data from government healthcare programs, such as Medicare and Medicaid.
  6. Expand Health Savings Accounts (HSAs) and other tax-preferred health accounts. The order directs the Secretary of the Treasury within 120 days to issue guidance, expanding the ability of patients to select high-deductible health plans that can be used along aside an HSA.

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