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By letter dated April 13, 2021 (Letter),
the Democrat and Republican leadership of the House Committee on
Energy and Commerce and its Subcommittee on Health, wrote United
States Health and Human Services Secretary, Xavier Becerra, urging
HHS to provide robust oversight and enforcement of the Hospital Price Transparency
Rule (Rule).
The Rule, which became effective January 1, 2021, requires
hospitals to make available to the public a machine readable and
searchable file containing a list of standard charges
for all hospital items and services as well as to display 300
The Hospital Price Transparency Rule: Is it Worth the Cost of Compliance? | Proskauer - Health Care Law Brief
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New Federal Transparency Requirements Impacting Health Providers and Plans | Proskauer - Health Care Law Brief
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Wednesday, April 21, 2021
As promised, this is a follow-up to our first blog post on the new federal transparency requirements. In our prior post, we summarized the Hospital Price Transparency rule which went into effect on January 1, 2021, and here we discuss the transparency rules contained in the Consolidated Appropriations Act, 2021 (the “Act”), which apply to both health plans and health care providers.
Beginning January 1, 2022, the Act requires providers (individual practitioners and facilities) to send the health plan a “good faith estimated amount” of scheduled services, including any expected ancillary services and the expected billing and diagnostic codes for all items and services to be provided. This notice then triggers the health plan’s obligation to send enrollees an “Advanced Explanations of Benefits” (“AEOB”) prior to scheduled care (or upon patient request). If the patient is uninsured, the provider must send the notice directly to