Hospital price transparency: History, 2026 final rule, and pending request for information

BY Kianna L. Sitarski, Esq. and Michael R. Alexander, Esq., Brown & Fortunato, P.C.

Providers and patients alike are well versed in the concept of informed choice when it comes to evaluating a patient’s treatment options. Among other considerations, CMS has recognized the unfortunate reality that, in many cases, the financial impact of the treatment carries significant weight when it comes to the patient making an informed choice. In an effort to make this financial information readily available to patients, and under the statutory authority granted under 42 U.S.C. § 300gg‑18(e), CMS passed the Hospital Price Transparency Rule (“HPT Rule”). The HPT Rule required hospitals to publish several data points related to their “standard charges”, including: (i) gross charges, (ii) payor-specific negotiated rates, (iii) de-identified minimum negotiated rates; (iv) de-identified maximum negotiated rates, and (iv) discounted cash prices. In addition to the requirement that the hospital publicly post these data points in a machine-readable format, the HPT Rule required “hospitals to provide patients with an out-of-pocket estimator tool or payor-specific negotiated rates for at least 300 shoppable services” in a consumer-friendly format.

While the core tenants of the HPT Rule remain unchanged since its first iteration —effective January 1, 2021—the detailed requirements of the HPT Rule are constantly evolving. Effective January 1, 2026, and consistent with Executive Order 14221, the CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Final Rule (CMS-1834-FC) was finalized (the “2026 Final Rule”). The stated purpose of these changes is to enhance the clarity and standardization of hospital standard charges through several concerted measures, including but not limited to:

• Replacing the “Estimated Allowed Amount” data point with the (i) median allowed amount; (ii) the 10^thand 90^th percentile allowed amounts; and (iii) the count of allowed amounts.
• Modifying the Machine-Readable File (“MRF”) Affirmation Statement to ensure that the information provided is true, accurate and complete, and to require the hospital to name the chief executive officer, president, or senior official responsible for the accuracy and completeness of the MRF.
• Including the hospital’s organizational, or Type 2, National Provider Identifier(s) (“NPI”) in the MRFs as a general data element.

Additionally, the 2026 Final Rule imposes two important enforcement measures. First, it expressly provided a three-month delay in enforcement (until April 1, 2026) to allow hospitals time to update and validate their MRFs given the new data points required. Second, it provides a limited reduction in the penalties assessed for non-compliance with the HPT Rule. Specifically, so long as all conditions are satisfied, CMS has agreed to accept a 35% reduction in the amount of Civil Monetary Penalties (“CMPs”) if the hospital agrees to waive its right to an Administrative Law Judge hearing (a due process procedure otherwise afforded to alleged violators). In its explanation for this reduction of assessable penalties, CMS reasons that such waiver incentivizes and encourages faster (and likely less costly) resolution of HPT Rule violations.

Today, the 2026 Final Rule is in full effect and enforcement in all respects. However, further changes to the HPT are likely on the horizon. On July 7, 2026, CMS published a proposed rule to revise the Medicare Hospital Outpatient Prospective Payment System and the Medicare Ambulatory Surgical Center payment system for calendar year 2027 (“CMS-1850-P”), which includes a Request for Information (“RFI”) to improve the HPT Rule specifically with regard to “enhancing the comparability and usefulness of the consumer-friendly display requirements” and “the reporting of contract mechanisms such as outlier payments, stop-loss provisions, rate tiering, and carve-outs.” The deadline for comment is August 31, 2026. Following the comment period, we expect that CMS will issue another final rule to build upon and improve the existing HPT Rule requirements.

In addition to agency rulemaking, on February 25, 2025, Senator John Neely Keendy introduced the Hospital Transparency Compliance Enforcement Act (S. 729 (119^th Congress)) to amend 42 U.S.C. 300gg–18(e) to, among other things, require the Secretary to “publish a list of the name of each hospital that is not in compliance” with the then-current hospital standard charge reporting requirements and a formal imposition of CMPs for non-compliance. This bill has been referred to the Senate Committee on Health, Education, Labor, and Pensions. Though it is early in the process, it demonstrates the alignment of legislators and agencies on this issue.

Given the administrative and legislative emphasis on healthcare cost transparency, hospitals and hospital administrators should closely monitor legislative developments and CMS rulemaking to best ensure compliance with any changes that may be rolled out and effective in 2027.