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Review of CMS's Oversight of Hospital Price Transparency Rules

Announced on  | Last Modified on  | Project Number: A-07-22-06108
Status
Completed
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

CMS issued a final rule effective January 1, 2021, to improve transparency in health care costs by requiring hospitals to make their prices readily available for consumers. The rule applies to all hospitals regardless of how they are paid. CMS's final rule provided specific instructions on which items were to be included on the list as well as gross charges for each item or service, payer-specific negotiated charges for each item or service, the discounted cash price, and codes used by a hospital to identify each item or service. CMS has also outlined its monitoring and enforcement plan to ensure hospital compliance. Potential actions CMS may take for noncompliance include providing a written warning listing violations, requiring a hospital to create a corrective action plan, and imposing civil monetary penalties. To evaluate CMS's monitoring and enforcement of the hospital price transparency rule, we will review the controls in place at CMS and statistically sample hospitals to determine whether CMS's controls are sufficient to ensure that hospital pricing information is readily available to patients as required by Federal law. Additionally, if hospitals are not in compliance with CMS's rule for listing their charges, we will contact the hospitals to determine the reason for noncompliance and determine whether CMS identified the noncompliance and imposed consequences on the hospitals.

TIMELINE

REPORT PUBLISHED

Not All Selected Hospitals Complied With the Hospital Price Transparency Rule (A-07-22-06108)

25-A-07-008.01 to CMS - Closed Implemented
Closed on 04/01/2025
We recommend that the Centers for Medicare & Medicaid Services review noncompliant hospitals associated with our findings and, if CMS determines that the hospitals are noncompliant, execute CMS's enforcement measures, to include issuing warning notices, corrective action plans, and/or civil monetary penalties as applicable.

25-A-07-008.02 to CMS - Closed Implemented
Update expected on
We recommend that the Centers for Medicare & Medicaid Services use the information in this report and consider implementing changes suggested by hospitals, including providing written guidance clarifying the definition of "shoppable services" and developing a training and compliance program that is tailored for smaller hospitals.

25-A-07-008.03 to CMS - Closed Implemented
Closed on 03/07/2025
We recommend that the Centers for Medicare & Medicaid Services continue to strengthen its internal controls, to include allocating sufficient resources to maintain a robust program of reviews of the hospitals and their compliance with the HPT rule.

View in Recommendation Tracker
Work Plan Type
Office of Audit Services
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Financial Stewardship Hospitals
Target Groups
-
Financial Groups
Medicare A