In early December, CMS posted on its website a second round of FAQs about the price transparency guidelines the agency adopted earlier this year in the inpatient prospective payment system (IPPS) rulemaking for federal fiscal-year (FFY) 2019.  83 Fed. Reg. 41,144, 41,686 (Aug. 17, 2018).  The new FAQs clarify that hospitals are required to make public all their standard charges for items and services, including drugs and biologicals, even if not reflected on the hospital’s chargemaster.  Furthermore, the FAQs state that IPPS hospitals must report the standard charges for each of their diagnosis-related groups.  The new FAQs are available here. 

Section 2718(e) of the Public Health Service Act, as amended by the Patient Protection and Affordable Care Act (ACA), requires all hospitals in the United States to annually publish a list of their standard charges in a manner specified by the Department of Health and Human Services (HHS).  In the FFY 2015 IPPS final rulemaking, CMS said that hospitals can comply with section 2718(e) by making public their list of standard charges or their policies for allowing the public to view a list of those charges in response to an inquiry.  79 Fed. Reg. 49,853, 50,146 (Aug. 22, 2014).  Four years later, in the FFY 2019 IPPS final rulemaking, CMS changed its guidelines for complying with Section 2718(e) because the agency was concerned that “challenges continue to exist for patients due to insufficient price transparency.”  83 Fed. Reg. at 41,686.  Under the new guidelines, which took effect on October 1, 2018, hospitals are now required to make available, and update annually, a list of their current standard charges via the internet in a machine-readable format.  Id.

CMS published the first round of FAQs about the new price transparency guidelines in early October (available here).  Those instructions clarified, among other things, that a “machine-readable” format is one that can be easily imported and read into a computer system.  XML and CSV are acceptable formats, but PDF is not.  The first FAQs also state that participation in a state online price transparency initiative does not satisfy the price transparency guidelines.  As mentioned above, the second FAQs make clear that the guidelines apply to all items and services provided by the hospital, including drugs and biologicals, and that IPPS hospitals must report their standard charges for each diagnosis-related group.

One question not fully answered is what practical consequences, if any, will result if a hospital fails to comply with the new price transparency guidelines.  This is one of the several questions raised in the second round of FAQs.  CMS’s response is that “[t]he hospital will not be in compliance with the law,” and that “specific additional future enforcement or other actions that we may take with the guidelines will be addressed in future rulemakings.”