The President has issued an executive order that is intended to promote access to health care prices and improve existing price transparency requirements and enforcement. Following a similar executive order issued in 2019, the DOL, HHS, and IRS issued transparency in coverage (TiC) regulations that require most group health plans and insurers to make extensive price disclosures to the public in machine-readable files updated monthly. The disclosures must show negotiated rates for covered items and services between the plan or insurer and in-network providers, as well as historical payments to, and billed charges from, out-of-network providers. The regulations also require plans and insurers to disclose individualized cost-sharing information upon request to a participant, beneficiary, or enrollee, including an estimate of the individual’s cost-sharing liability for covered items or services furnished by a particular provider.
Executive Order 14221 directs the DOL, HHS, and IRS to take “all necessary and appropriate action” to implement and increase enforcement of the TiC regulations. Within 90 days, the agencies are to take action to require the disclosure of the actual prices of items and services, rather than estimates. They are also directed to issue updated guidance ensuring pricing information is standardized and comparable across plans, along with updated enforcement policies.
The executive order does not change any laws or regulations, and its ultimate impact will not be known until the agencies issue the requested regulations and guidance. Nevertheless, sponsors of employer-provided health plans and their advisors will appreciate the heads-up that changes and increased enforcement may be coming in 2025.
