CMS proposes tightening insurer price transparency requirements

Modern Healthcare – Friday, December 19, 2025
By Nona Tepper

The Trump administration Friday proposed refining health insurance companies’ price transparency requirements.

The Centers for Medicare and Medicaid Services issued a draft regulation that would change how health insurance companies and employers must disclose their negotiated rates with providers.

“Americans have a right to know what healthcare costs before they pay for it,” Health and Human Services Secretary Robert Kennedy Jr. said in a news release Friday.

During President Donald Trump’s first term in 2020, CMS finalized the “Transparency in Coverage” rule requiring most health insurers and self-insured plans to disclose their pricing and cost-sharing information.

The rule was intended to help consumers navigate the healthcare system while promoting competition, but CMS said in the Friday news release the effort has been hampered by oversized files, duplicative data and unstandardized information.

President Donald Trump in March ordered federal agencies to develop enhanced price transparency requirements for health plans and providers.

In the draft regulation, CMS wrote that it aims to improve the quality of data by reducing the number of services carriers must disclose pricing for, as well as the frequency with which carriers must update the information.

CMS proposed requiring carriers to:

Exclude pricing information for services that a provider is unlikely to provide, such as the negotiated heart surgery rate for a podiatrist’s office.
Organize in-network pricing based on provider network, rather than by the individual policy level.
Update their pricing information quarterly, rather than monthly, and highlight what has changed from one version of the file to the next.

CMS also proposed expanding carriers’ out-of-network reporting requirements by lowering the claims threshold needed to report the rate paid to uncontracted providers to 11 claims over nine months, rather than 20 claims over 180 days.

The draft regulation additionally would require carriers to organize their out-of-network allowed amounts at the product level. In other words, they would need to define the rates self-insured, individual or small group plans must pay out-of-network.

The agency wrote that it plans to address how carriers disclose the price consumers pay for prescription drugs in a separate rule.

AHIP said the trade group is closely reviewing the draft regulation.

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