- On March 10, 2025
- Trump Administration
The Trump administration has released another executive order (EO) with the potential to impact employers. It is titled “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information.” This EO, intended to increase enforcement of price transparency requirements, orders the Department of Labor, Treasury, and Department of Health and Human Services (the Departments) to “improve existing price transparency requirements.” Within 90 days of the EO, the Departments must:
- Require the disclosure of actual prices of items and services, not estimates;
- Issue updated guidance or proposed regulatory action ensuring pricing information is standardized and easily comparable across hospitals and health plans; and
- Issue guidance or proposed regulatory action updating enforcement policies designed to ensure compliance with the transparent reporting of complete, accurate, and meaningful data.
This EO will expand on detailed price transparency regulations issued by the first Trump administration to implement the Affordable Care Act (ACA). Under previous ACA Transparency in Coverage (TiC) rules, non-grandfathered group health plans and health insurers are required to furnish cost-sharing information on request to participants and beneficiaries. These disclosures include estimates of an individual’s cost-sharing liability for covered items or services furnished by a health provider. Additionally, plans must publicly post on a website information in three machine-readable files (MRFs) that include:
- In-network provider rates for covered items and services;
- Out-of-network allowed amounts and billed charges for covered items and services; and
- Negotiated rates and historical net prices for covered prescription drugs
The MRFs are applicable for plan years beginning on or after January 1, 2022. Health plans can satisfy their compliance requirements by entering into a written agreement that their service provider (e.g., carrier, TPA, or health care claims clearinghouse) will publicly post the MRFs on its own public website on behalf of the plan. However, self-insured plans still retain liability if the other party fails to post the files, so it is prudent to monitor third-party compliance. Additional provisions to promote price transparency were enacted under the Consolidated Appropriations Act of 2021.
Please contact your ExpressLink representative with any questions.