2022 HOPPS Final Rule Addresses Hospital Price Transparency

New Rule Finalizes Penalties for Violating the 2021 Price Transparency Rule

On November 2, 2021, CMS published the 2022 Hospital Outpatient Prospective Payment System Final Rule that addressed its previously-proposed penalties for hospital non-compliance with price reporting requirements.

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The 2021 Price Transparency Final Rule, effective January 1, 2021, required hospitals to publish their charges based on five categories:

  • Gross Charges: non-discounted rates listed in the hospital’s chargemaster
  • Discounted Cash Prices: rates for individuals paying cash or cash equivalents
  • Payer-Specific Negotiated Charges: rates negotiated with a third-party payer for an item or service
  • De-identified Minimum Negotiated Rates: lowest rates negotiated with all third-party payers
  • De-identified Maximum Negotiated Rates: highest rates negotiated with all third-party payers

Effective January 1, 2022, hospitals with 30 or fewer beds that are not in compliance with the 2021 Rule face a minimum civil monetary penalty of $300 per day. Hospitals with greater than 30 beds face a penalty of $10 per bed per day. The maximum daily penalty is capped at $5,500 per day.
 
Annually, the minimum total penalty is $109,500 per hospital; the maximum total penalty is $2,007,500 per hospital.
 
The display copy of the Final Rule is available here and scheduled for publication in the Federal Register on November 16, 2021.

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