CMS Proposes Update to Transparency Rules for Health Service Pricing

Last Friday, the Centers for Medicare and Medicaid Services (CMS) issued a new proposed rule that would overhaul disclosure rules for health payers’ pricing and cost-sharing determinations.

The 2020 Transparency in Coverage (TiC) rule required payers to disclose cost-sharing information in a machine-readable format and create personalized online tools for consumers to access pricing information. According to TechTarget, compliance has been relatively low, so the Trump administration has determined that it would overhaul the rule to eliminate barriers to achieving the price transparency goals of the TiC rule.

These changes would include bringing the disclosure requirements in line with the Hospital Price Transparency rules for pricing data disclosure, including a change-log and utilization files so that consumers can see changes reflected in the data. It also reduces the frequency with which the pricing information must be updated from monthly to quarterly.

The proposal would expand carriers’ out-of-network reporting requirements by lowering the threshold needed to report the rate. It would also require carriers to organize their out-of-network allowed amount at the product level, meaning that they would need to define the rates self-insured, individual or small group plans would pay out-of-network, Modern Healthcare explains.

The proposed rule will have 60 days for public comment and is published in the Federal Register. The comment period will close on February 23, 2026.