On May 22, 2025, the Departments of Health and Human Services, Labor, and the Treasury (the “tri-agencies”) issued a press release announcing several actions to enhance health care price transparency, including two new guidance documents and two requests for information (RFIs). Through these steps, the tri-agencies “aim to curb rising health care costs, promote competition, and empower patients.” For the most part, these actions, which will roll out over several months and perhaps years, mark the start of a process to make hospital and health plan price transparency data more accessible and useful.
The actions were in response to an earlier executive order from President Trump, discussed in a previous article. That order did not directly make changes; rather, it instructed the tri-agencies to further implement and enforce existing federal hospital and health plan price transparency rules and to issue further guidance by May 26, 2025.
The original rules, established during the first Trump administration and strengthened under the Biden administration, aim to spur competition and drive down costs by arming consumers, employers, researchers, and policymakers with long-hidden health care prices. Although hospitals and health plans are posting a massive amount of health care price data in response to these rules, actionable information on prices is not readily and widely available, partly due to ongoing issues with the accessibility and quality of the data.
Background On Price Transparency Rules
The first Trump administration established federal rules authorized by the Affordable Care Act that require hospitals and health plans to post their prices, including previously proprietary rates negotiated between payers and providers. They must post prices in two different formats: 1) a consumer-friendly format meant to help patients see costs upfront and shop for care, and 2) machine-readable files (MRFs). While not intended to be directly accessed by consumers, MRFs are nonetheless meant to benefit the public. The health plan price transparency rule, for example, envisions that MRFs would be accessed by users such as researchers, policymakers, state and federal regulators, employers, and app developers, who would leverage the data to deliver “more targeted oversight, better regulations, market reforms to ensure healthy competition, improved benefit designs, and more consumer-friendly price negotiations.”
Hospital Price Transparency Implementation
The Hospital Price Transparency rules took effect in January 2021. They require hospitals to post “standard charges,” including payer-specific negotiated rates, gross charges, discounted cash prices, and minimum and maximum negotiated rates for each item or service provided.
The Centers for Medicare and Medicaid Services (CMS) updated rules in subsequent years to require hospitals to post price data in a more uniform way, include additional context on price data, and make online price files easy to find. CMS also stepped up enforcement actions and increased the maximum civil monetary penalty for non-compliance, which was associated with improved compliance by hospitals. CMS has assessed penalties on 27 hospitals to date.
Despite these steps, recent reports show that data quality and hospital compliance remain ongoing issues. A 2024 report by the Department of Health and Human Services Office of Inspector General estimated that 46 percent of hospitals were not fully compliant with the rules based on its audit of a sample of hospitals. Furthermore, a 2024 Government Accountability Office report found that hospital data quality issues have prevented large-scale, systematic use of the data.
Transparency In Coverage Implementation
The Transparency in Coverage (TiC) rules, which apply to health insurers and group health plans, took effect in July 2022. They require health plans to post three separate MRFs each month that contain: 1) in-network negotiated rates for all covered items and services, 2) out-of-network allowed amounts and billed charges for all covered items and services, and 3) negotiated rates and historical net prices for covered prescription drugs.
The tri-agencies have not yet implemented the prescription drug MRF requirement from the TiC rules. They deferred enforcement of this provision in August 2021 and, two years later, rescinded that approach, but they have not yet released the final technical specifications needed for prescription drug pricing MRFs.
Health plans appear to have complied more readily with MRF requirements than hospitals, though oversight is challenging, and compliance remains inconsistent. The tri-agencies have not, to date, announced plans to assess health plan compliance nor taken any enforcement actions.
Researchers and other stakeholders have identified a long list of issues that make data in TiC MRFs hard to access, analyze, and draw meaningful conclusions from. For example, the massive size and complexity of the files prevent most entities from accessing the data outside of commercial data vendors that have the costly and specialized infrastructure that is required. Accordingly, while the best-resourced stakeholders can buy data extracts and insights, actionable information from the data isn’t widely available to consumers, employers, regulators, and policymakers.
Updates Announced For Hospital Price Transparency
In May, CMS announced two actions to improve hospital price transparency MRFs: 1) updated guidance to hospitals on posting prices in dollar amounts, and 2) an RFI on improving compliance with hospital price transparency requirements.
The updated guidance reinforces CMS’s expectation that hospitals disclose negotiated rates as dollar amounts. CMS acknowledged in this and previous guidance that there are circumstances in which hospitals cannot readily derive a prospective dollar-value price. For example, when a negotiated rate is set as a percentage of a fee schedule that the hospital does not have access to, or when the rate is determined by an algorithm that yields variable dollar amounts rather than a simple or static dollar value. To convey context in dollars and cents in these circumstances, CMS introduced a new data element, the “estimated allowed amount,” starting in 2025 to capture the average historical amount received for a service from a specific payer.
Prior guidance recommended that hospitals use the code “999999999” when needed to indicate that the hospital lacks sufficient historical data to calculate an estimated allowed amount. CMS believes that hospitals have used this code more frequently than is necessary. For example, CMS notes that, in a sample of 68 MRFs from large hospitals, 38 percent used “999999999” for more than 90 percent of estimated allowed amount values. To produce more meaningful and comparable hospital price transparency data, CMS is discontinuing the use of the “999999999” code and providing additional guidance on how to calculate estimated allowed amounts in special circumstances, such as when there are few or no claims for a service within the prior 12 months.
CMS also issued an RFI soliciting input on ways the agency can improve hospital compliance and price transparency enforcement to ensure that data are accurate and complete. CMS is encouraging input from the range of stakeholders who utilize the hospital price transparency MRFs, including hospitals, innovators, employers, researchers, and consumers. CMS will accept responses through July 21, 2025, and will use the information collected to inform the development of future policies and processes.
Updates Announced For Health Plan Price Transparency
In May, the tri-agencies also announced two actions to implement and improve health plan price transparency MRFs: 1) an RFI on improving prescription drug price transparency, and 2) guidance on a future update to the technical specifications for TiC data.
The tri-agencies released an RFI to get input on implementing the prescription drug MRF requirements under the TiC rules. They are seeking information on data elements, for example, whether and how to capture pricing information for different dosage units, and on the required format and related state approaches. Comments will be due 30 days after the RFI is posted in the Federal Register. The agencies intend to use the information collected to inform future rulemaking or guidance, including, presumably, the final technical specifications needed to implement the long-delayed prescription drug MRF.
The tri-agencies also released new guidance in the form of a frequently asked questions (FAQs) that lays out the process and timeline for creating an updated second version of the technical specifications payers use when publishing data in their in-network and out-of-network MRFs. The tri-agencies will repeat the same collaborative and iterative process used to develop the first version through their existing online platform. The tri-agencies aim to finalize the updates by October 1, 2025, and require plans and issuers to publish MRFs using the new specifications as of February 2, 2026.
The FAQs explain that the goal of updating TiC technical specifications is to address issues with accessibility due to large file sizes, data integrity, and a lack of information needed for users to contextualize the data. The tri-agencies anticipate that future updates to technical specifications will, at a minimum, include changes to file structures and data elements to reduce data redundancy and add reporting of provider network information. The tri-agencies also flagged that they may undertake future rulemaking to further improve TiC MRF requirements.
Many, but not all, of the issues that limit access to and use of TiC data could be mitigated through updates to the TiC technical specifications. Massive TiC file sizes, which render MRFs inaccessible for most would-be users, are a common complaint, and data redundancy is one contributing factor that unnecessarily inflates file sizes. For example, an analysis published in a Forefront article by Yang Wang and collaborators found that almost half of TiC price files posted by six major insurers were duplicates. Other common complaints about TiC data—such as substantial irrelevant data (referred to as “ghost rates” or “zombie rates”) and reporting of multiple, conflicting prices—are not explicitly mentioned as targets in the FAQs. Time will tell if they are addressed as part of this effort.
Looking Ahead
For the most part, the recent tri-agency announcements mark the start of a process to collect input and update price transparency guidance that will unfold over several months and possibly years. Taken together, the actions provide a high-level roadmap of where the second Trump administration will focus its initial price transparency efforts: on improving access to and the utility of TiC data, implementing prescription drug price transparency requirements, and improving hospital compliance and accuracy. This roadmap focuses on improvements to just machine-readable files and not to the consumer-facing pieces of price transparency rules, and it notably lacks any mention of assessing health plan compliance with MRF requirements. But the actions announced otherwise broadly touch on many of the known issues with the implementation of MRF requirements and could ultimately make meaningful and actionable price information more readily available to consumers, employers, regulators, policymakers, and other stakeholders.
Stacey Pogue “Federal Officials Announce Steps To Strengthen Health Care Price Transparency” June 4, 2025, https://www.healthaffairs.org/content/forefront/federal-officials-announce-steps-strengthen-health-care-price-transparency. Copyright © 2025 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.
