Proposed Federal Regulation Pushes for More Price Transparency in Health Plans

Quick Hits

• The IRS, DOL, and HHS recently issued a proposed rule to “improve the standardization, accuracy, and accessibility of public pricing disclosures” in group health plans.
• The proposal builds on a 2020 final regulation on price transparency in health care.
• The proposed regulations would take effect twelve months after publication of the final regulations and for plan years beginning on or after January 1, 2027.

Since July 2022, nongrandfathered group health plans and health insurers have been required to post machine-readable files each month for each plan or coverage they offer. This includes an in-network rate file, disclosing in-network rates for all covered items and services; an allowed amount file, disclosing out-of-network allowed amounts and the associated billed charges; and a prescription drug file, disclosing in-network rates and historic net prices for covered items and services.

If finalized, the proposed rule would:

• require health plans to exclude from the in-network rate files certain data for services providers would be unlikely to perform;
• require health plans to organize in-network rate files by provider network, rather than by plan;
• require change-log and utilization files, so users can identify what has changed from one in-network rate file to the next and understand which in-network providers are actively providing which items and services;
• reduce in-network rate and allowed amount files from monthly to quarterly; and
• reorganize the allowed amount files by health insurance market type, reduce the claims threshold to eleven or more claims, and increase the reporting period from three months to six months and the lookback period of data from 180 days to nine months.

In addition, the proposed rule would align with consumer protections established under the federal No Surprises Act. Group health plans would be required to provide the same price information online, in print, or by telephone.

To make the information easier to find, the proposed rule would require group health plans to post a plain text file located in the root folder of a payer’s website with information on the specific location of the machine-readable files and contact information for the people who are responsible for the machine-readable files. It also would require group health plans to add a link in the footer of the home page of the plan’s website titled “Price Transparency” or “Transparency in Coverage” that routes directly to the web page that hosts the machine-readable files.

The Centers for Medicare and Medicaid Services (CMS) published a fact sheet with information about the proposed rule, which amends another regulation from 2020.

Next Steps

The public has until February 23, 2026, to submit comments on the proposed rule. It is unclear when a final rule may be released.

Health insurers and employers with self-insured health plans may wish to review their policies and practices for disclosing price information to ensure that they comply with federal regulations that are already in effect. They may wish to consider any adjustments that may be needed if the proposed rule takes effect.

Ogletree Deakins will continue to monitor developments and will provide updates on the Employee Benefits and Executive Compensation and Healthcare blogs as new information becomes available.

This article and more information on how the Trump administration’s actions impact employers can be found on Ogletree Deakins’ Administration Resource Hub.

Karen N. Brandon is a shareholder in Ogletree Deakins’ Morristown office.

This article was co-authored by Leah J. Shepherd, who is a writer in Ogletree Deakins’ Washington, D.C., office.

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