AHIP speaks out against proposed Transparency in Coverage rule

By | January 31, 2020

Requiring the public disclosure of insurers’ negotiated rates with providers exceeds the statutory authority of the Department of Health and Human Services, the head of America’s Health Insurance Plans told HHS Secretary Alex Azar and other federal agencies in a January 29 letter.

The proposed rule also risks requiring disclosure of consumers’ sensitive, personally identifiable information with third party app developers that are not bound by patient privacy laws, AHIP President and CEO Matt Eyles said by statement.

The rule for insurers would not provide information that is helpful to consumers, Eyles said. Governmental agencies like the Federal Trade Commission, Department of Justice and the Congressional Budget Office have expressed concern over the public disclosure of trade secrets and competitively sensitive, proprietary information like payer-negotiated rates that could reduce competition and raise prices for consumers.


AHIP is participating in the comment process for the proposed rule that would force insurers to disclose private and competitively negotiated rates.

CMS is expected to weigh comments before deciding whether to release a final rule.

Hospitals are already under a mandate to disclose their negotiated contract prices with insurers. That rule is scheduled to go into effect in 2021, but hospital groups, including the American Hospital Association, have sued to stop it from going forward.

A similar rule for insurers could also face pushback.

“In short, the proposed rule is contrary to statute, effects a taking of health insurance providers’ trade secrets, unconstitutionally compels speech, and is arbitrary and capricious,” Eyles said in his letter to Azar and the heads of the departments of Treasury and Labor.

Eyles recommends a more consumer-friendly and workable approach to achieve the goal of transparency so that all enrollees covered by the proposed rule will have access to comprehensive price transparency tools within two two years.


The rules are aimed at giving consumers price transparency in what they pay for healthcare procedures and come out of President Trump’s Executive Order in June 2019 on “Improving Price and Quality Transparency in American Healthcare to Put Patients First.”

The executive order directed the secretaries of the Departments of Labor, Health and Human Services and the Treasury to issue an advance notice of proposed rulemaking, soliciting comment on a proposal to require providers, insurers, and self-insured group health plans to provide or facilitate access to information about expected out-of-pocket costs for items or services to patients before they receive care.

In the 2020 Payment Notice proposed rule, HHS sought input on ways to provide consumers with greater transparency regarding their own healthcare data, qualified health plan offerings on the federally-facilitated exchanges for Affordable Care Act coverage, and on the cost of services, according to the proposed rule published in the Federal Register.

“Commenters on the 2020 Payment Notice overwhelmingly supported the idea of increased price transparency,” the agencies said. “Many commenters provided suggestions for defining the scope of price transparency requirements, such as providing costs for both in-network and out-of-network healthcare, and providing healthcare cost estimates that include an accounting for consumer-specific benefit information, like progress toward meeting deductibles and out-of-pocket limits, as well as remaining visits under visit limits. Commenters expressed support for implementing price transparency requirements across all private markets and for price transparency efforts to be a part of a larger payment reform effort and a provider empowerment and patient engagement strategy.”

Some commenters advised HHS to consider how such policies should be implemented, warning against federal duplication of state efforts and requirements that would result in group health plans and health insurance issuers passing along increased administrative costs to consumers, and cautioning that the proprietary and competitive nature of payment data should be protected.


“We fully support the goal of empowering Americans with easily accessible cost and quality information to make more informed decisions,” Eyles said. “AHIP strongly urges the Departments to adopt workable solutions that ensure healthcare information is personalized, easy to understand, accurate, and actionable, focusing on health care treatments and services for which consumers can actually shop.”

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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