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Outlawing the Opaque:

December 13, 2023

Congress Set to Vote on Transparency Mandate

Seeing non-descript shapes and fuzzy images is a common occurrence for those driving on a stormy night with fogged-up windshields. You can see lights coming at you, but you can’t see the road itself or its yellow dividing line. The murkiness of the view can be downright dangerous—even with wipers going at full tilt. In such conditions, it is imperative to get a clearer view—whether that means turning on the defrost or manually wiping away the film of fog with your own hand.

Gaining clarity, sharpening the scene can be critical in helping individuals to better interpret and react to the myriad of data points constantly coming into view. Whether that’s navigating hazardous driving conditions or selecting a healthcare provider in the wake of a concerning diagnosis. As it concerns the latter, greater clarity may be on the way.

Transparency on Track

According to a December 11 article in Becker’s CFO Report, the U.S. House of Representatives could call for a vote in the next few days on The Lower Costs, More Transparency Act (LCMTA). The measure would force hospitals, ambulatory surgery centers, labs, imaging service providers and pharmacy benefit managers to meet new price transparency requirements. The bipartisan legislation, which was first introduced on September 8, not only seeks to improve price transparency but also contains provisions meant to lower overall costs for patients and employers.

According to Beckers, the key takeaways from the proposed LCMTA include the following items:

  1. The legislation would require healthcare price information from hospitals, payers, labs, imaging providers and ASCs to publicly list the prices they charge patients.
  1. Hospitals would be required to publish all standard charges for at least 300 shoppable items and services. The charges would be published through machine-readable files and would have to include payer-specific negotiated charges in addition to charges for cash-paying patients.
  1. Under the proposed legislation, ASCs, when owned by a hospital, would be required to make public insurer-negotiated rates and cash prices for all items and services, as well as prices for approximately 300 shoppable services.
  1. The proposed bill would also reduce costs for patients and employers by requiring payers and pharmacy benefit managers to disclose negotiated drug rebates and discounts, revealing the true costs of prescription drugs.
  1. Medicare Advantage organizations would be required to report to the U.S. Department of Health and Human Services (HHS) information about PBMs, pharmacies and other providers when they share common ownership.
  1. The proposed bill would eliminate $8 billion a year in proposed disproportionate share hospital cuts during fiscal year 2024 through 2025, as well as $7 billion in funding for the Medicaid Improvement Fund.
  1. The legislation would lower out-of-pocket costs for seniors who receive medication at a hospital owned facility or physician office and expand access to more affordable generic drugs.
  1. Under the bill, employers would be equipped with the drug price information they need to get the best deal possible for their employees.
  1. The proposed bill also fully pays for investments into programs that strengthen the healthcare system by the following actions:
  • The funding of community health centers, deemed crucial for patients in rural and underserved areas, would be extended through 2025. The proposed funding is $4.4 billion per year.
  • Supporting training programs for new physicians in communities.
  • Preserving Medicaid funding for hospitals that provide care to uninsured and low-income patients.
  • Extending funding for research to find better treatments and a cure for diabetes, which CMS said affects more than 38 million Americans.

Rationale and Next Steps

In a September 8 press release, Rep. Virginia Foxx, chair of the House Education and the Workforce Committee, stated the following:

Hidden fees, dishonest billing, and other harmful practices in the healthcare industry have left patients in the dark about the cost of care. No patient should be saddled with higher premiums just because he or she wasn’t presented with all of the facts. This good faith effort will allow patients to cut through the confusion in the healthcare marketplace and make informed decisions.

The House could vote on the LCMTA this week. If passed, it would then have to proceed through the next steps of approval before becoming law. We will keep you updated on the bill’s progress.

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