On February 25, 2025, the White House issued a new executive order aimed at implementing many of the Administration's previously issued directives to health plans. During his first term in 2019, President Trump issued an executive order on health care price and quality transparency supported by Section 1311(e)(3) of the ACA, which imposes transparency, reporting, and disclosure requirements on qualified health plans. The new executive order directs the Departments of the Treasury, Labor, and Health and Human Services (“Departments”) to rapidly implement and enforce the healthcare price transparency regulations.
As a reminder, as noted in previous blog posts, in 2020, the Departments issued final rules requiring health plans and insurers to make cost-sharing information available for all items and services available under the plan via a machine-readable file on a public website for plan years beginning on or after January 1, 2024. These files are required to provide pricing data for covered items, services, and drugs based on in-network negotiated payment rates and historical out-of-network allowed amounts. However, in 2023, the Departments issued guidance noting that enforcement discretion for these requirements would be conducted on a case-by-case basis, taking into account the difficulties for plans and issuers to determine and report this data.
It appears that under the new executive order, the new administration plans to ramp up its enforcement activities to ensure that health plans remain in compliance. The President has specifically directed the Secretary of the Treasury, the Secretary of Labor, and the Secretary of Health and Human Services to take all necessary and appropriate action within 90 days to:
- require the disclosure of the 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.
Plans that have not started posting their machine-readable files, or who may not have all services posted on a public website should work with their TPA and counsel to ensure that they are in compliance. If you have any questions about the transparency rules or any employee benefits-related issues, please contact any of the Bricker Graydon employee benefits team.
