The Centers for Medicare & Medicaid Services (CMS) has finalized changes to hospital price transparency regulations, aligning with President Biden's Executive Order 14221. These modifications aim to provide patients with clear and actionable healthcare pricing information, ensuring hospitals disclose actual prices and facilitate easy comparison across different facilities. The new policies will be part of the calendar year 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center final rule.
CMS is requiring hospitals to replace estimated allowed amounts with median allowed amounts in their machine-readable files (MRF). Additionally, they must include the 10th and 90th percentile allowed amounts. Hospitals will encode these figures in dollars when a payer-specific negotiated charge is based on a percentage or algorithm. A lookback period of no less than 12 months and no longer than 15 months prior to posting the MRF is also mandated.
Furthermore, CMS has established regulations at 45 CFR § 180.50 that require hospitals to attest that all standard charge information is true, accurate, and complete as of the date in the file. This includes encoding the name of a senior official responsible for overseeing data accuracy.
To enhance comparability with other healthcare data, hospitals must encode their Type 2 National Provider Identifier(s) (NPIs) in the MRFs. These identifiers are associated with primary taxonomy codes indicating hospital or hospital unit status.
In terms of compliance enforcement, CMS will reduce civil monetary penalties by 35% if a hospital waives its right to an administrative law judge hearing. However, this reduction won't apply if noncompliance pertains to core requirements such as failing to make public an MRF or shoppable services in a consumer-friendly format.
These revisions will take effect on January 1, 2026, but enforcement will be delayed until April 1, 2026, allowing hospitals time to update systems and validate data.
For more details on these changes, visit the Federal Register: https://www.federalregister.gov/documents/current
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