SPOTLIGHT ON LEGISLATIVE DEVELOPMENTS
Assessing the Impact of Pricing Transparency Legislation Implementation on Managed Care Networks
Henry Ford Health System and Health Alliance Plan of Michigan
The transparency rule, requiring hospitals to publish a consumer-friendly list of payor-negotiated rates for healthcare services went into effect on January 1, 2021. It’s unclear whether Biden will revise the rule, finalized by the CMS in late 2019 or if the new administration will exercise enforcement discretion as providers work to implement the change. This session will explore impact on both payors and providers.
- Status update on CMS transparency rules and projected impact on managed care networks
- Anticipating potential friction due to interoperability hurdles for information sharing from MCOs to providers and members
- Examining how CMS enforcement measures are being applied
- How to overcome operational challenges to achieve compliance