CMS steps up enforcement and fines of hospitals in noncompliance with price transparency rule

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The Centers for Medicare and Medicaid Services is cracking down on enforcing the price transparency rule through fines and has released the names of four hospitals that have not complied and have received monetary penalties.

CMS will now automatically impose a civil monetary penalty on hospitals that fail to submit a Corrective Action Plan at the end of the 45-day CAP submission deadline.

The hospitals fined are Northside Hospital Atlanta in Georgia, fined $883,180; Northside Hospital Cherokee in Georgia, fined $214,320; Frisbie Memorial Hospital in New Hampshire, fined $102,660; and Kell West Regional Hospital in Texas, fined $1127,260. CMS took actions against the Georgia hospitals in June 2022, and against the hospitals in New Hampshire and Texas on April 19.

WHY THIS MATTERS

CMS said Wednesday it is updating the enforcement process. CMS will continue to enforce the requirement that hospitals that are out of compliance with the regulation submit a Corrective Action Plan within 45 days from when CMS issues the CAP request. 

CMS will also now require hospitals to be in full compliance with the hospital price transparency regulation within 90 days from when CMS issues the CAP request, rather than allowing hospitals to propose a completion date for CMS approval, which can vary.  This change will standardize and streamline the timeframe and promote compliance at earlier dates, CMS said.

Currently, CMS does not impose automatic civil monetary penalties for failure to submit a requested CAP or failure to come into compliance within 90 days.

CMS will now automatically impose a CMP on hospitals that fail to submit a CAP at the end of the 45-day CAP submission deadline. Before imposing the fine, CMS will re-review the hospital's files to determine whether any of the violations cited in the CAP request continue to exist and, if violations are found, impose a penalty.

For hospitals that submit a CAP by the 45-day CAP submission deadline but fail to comply with the terms of that CAP by the end of the 90-day deadline, CMS will re-review the hospital's files to determine whether any of the violations cited in the CAP request continue to exist and, if so, it impose an automatic penalty.

For hospitals that have not made any attempt to satisfy the requirements (i.e., those that have not posted any machine-readable file or shoppable services list/price estimator tool), CMS will no longer issue a warning notice to the hospital and will instead immediately request that the hospital submit a CAP. Currently, CMS does not issue CAP requests without first issuing a warning notice.

These enforcement updates will shorten the average time by which hospitals must come into compliance with the hospital price transparency requirements after a deficiency is identified to no more than 180 days, or 90 days for cases with no warning notice, and will complement future efforts, CMS said.  

CMS is leveraging automation to complete hospital reviews quickly, accurately, and consistently. By using automation to group complaints based on file types and hospital systems, CMS has increased the number of comprehensive reviews conducted from 30-40 per month to over 200 comprehensive reviews per month.

THE LARGER TREND

As of this month, CMS has issued more than 730 warning notices and 269 requests for CAPs. CMS has imposed CMPs on four hospitals for noncompliance.

The final rule issued in 2019 and which took effect in January 2021, establishes requirements for hospitals to establish, update and make public a list of their standard charges for the items and services that they provide.

A 2022 survey found that less than 20% of hospitals were in compliance.

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org