New report finds nine Maine hospitals are noncompliant on federal price transparency rule

0
26

At least nine Maine hospitals are not complying with a federal price transparency rule, according to the findings of a report recently released by a patients advocacy group. 

Patient Rights Advocate released a report in February surveying 1,000 hospitals and found only 14.3% were in compliance with a Centers for Medicare and Medicaid Services (CMS) rule requiring hospitals to post their standard charges both in a machine readable file and as a consumer-friendly display of shoppable services.

The survey included nine Maine hospitals and found none to be in compliance with the law. Calais Regional Hospital in Calais, Central Maine Medical Center (CMMC) in Lewiston, Maine General Medical Center in Augusta, Maine Medical Center (MMC) in Portland, Mid Coast Hospital in Brunswick, Southern Maine Healthcare in Biddeford, and Eastern Maine Medical Center (EMMC), Northern Light Acadia Hospital, and St. Joseph Hospital in Bangor, were all found to be noncompliant with the CMS rules under the study’s methodology.

Patient Rights Advocate findings are based on a number of criteria, including whether a hospital is posting mandated codes used for billing, gross charges for at least 50% of its services, discounted cash prices for at least 50% of its services, the negotiated minimum and maximum charges for at least 50% of their items and services, the payer-specific negotiated rates for at least 50% of their items and services, and whether the hospital posted all negotiation charges for at least two third-party payers and plans. This includes insurance carriers like Blue Cross Blue Shield, Anthem and Humana.

Failure to meet any of these criteria led to a hospital included in the survey being found noncompliant with CMS’ requirement that hospitals post machine readable charges.

The survey also analyzed whether hospitals posted a list of 300 shoppable services, a specific requirement of the CMS rule, and a functional price estimator tool. If hospitals posted a price estimator tool, the survey also analyzed whether it listed cash prices available to people without insurance.

Its review of Maine hospitals was conducted between December 17 and December 28, 2021. All nine hospitals were found noncompliant with having a complete list of standard charges on file. Only Maine General did not have codes on file. All nine hospitals provided gross charges. Maine General and CMMC did not list discounted cash prices or post negotiated minimum and maximum or negotiated rates., but the rest of the surveyed hospitals did.

St. Joseph, Northern Light Acadia, EMMC, CMMC, Maine General, and Calais Regional did not list all payers and plans. Only Calais Regional provided a list of 300 shoppable services. All hospitals surveyed but Southern Maine provided a price estimate tool. Of the surveyed hospitals that provided a price estimate tool, only Mid Coast Hospital did not list cash prices for individuals without insurance in their price estimation tool.

The CMS ruling went into effect on January 1, 2021 and was put in place under former president Donald Trump’s administration under the authority of the Affordable Care Act. The penalty for noncompliance with the rule was raised under President Joe Biden’s administration.

Throughout 2021, hospitals could be fined up to $300 per day for each day they were out of compliance with the price transparency law. The structure of the penalty changed beginning January 1, 2022. Hospitals with 30 beds or less can still be fined up to $300 per day, but hospitals with between 31 and 550 beds can be fined $10 for each bed they have. Hospitals with greater than 550 beds can be fined up to $5,500 per day. Hospitals must pay the fine within 60 days of being notified they are out of compliance with the law.

LEAVE A REPLY

Please enter your comment!
Please enter your name here