CMS Proposes New Healthcare Price Transparency Rules to Simplify Data Access

On December 19, the Centers for Medicare & Medicaid Services (CMS), in partnership with the Department of Labor and the Department of the Treasury, jointly proposed updates to the healthcare price transparency rules established during President Trump’s first term.

According to a CMS press release, the proposals in this rule would enhance the impact of pricing information by reducing file complexity and size, making data more transparent, and producing more information for consumers, employers, and innovators.

The Transparency in Coverage data has been challenging to access and navigate, CMS stated. “Oversized files, duplicative data, and information that could not be easily compared across the health insurance landscape have limited its use and reliability.” The proposals aim to address these barriers by simplifying data organization, eliminating unnecessary information, and making consumer-facing cost tools more accessible to a broader range of consumers.

Improvements were listed as follows:

• Requiring plans and issuers to exclude from the In-network Rate Files certain data for service providers would be unlikely to perform.
• Reorganizing In-network Rate Files by provider network rather than by plan, cutting redundancy, and aligning with how most hospitals report data pursuant to the Hospital Price Transparency requirements.
• Requiring Change-log and Utilization Files so users can easily identify what has changed from one In-network Rate File to the next, and have clear information on which in-network providers are actively furnishing which items and services.
• Reducing reporting cadence for In-network Rate and Allowed Amount Files from monthly to quarterly, significantly reducing burden while maintaining meaningful transparency.
• Increasing the amount of out-of-network pricing information reported by reorganizing Allowed Amount files by health insurance market type, reducing the claims threshold to 11 or more claims, and increasing the reporting period from 90 days to 6 months and the lookback period of data from 180 days to 9 months. 

“Every person deserves to know what their healthcare will cost without needing a team of analysts to decode it,” said CMS Administrator Dr. Mehmet Oz, in a statement.

Feedback from stakeholders is requested during the 60-day comment period on all elements of the proposed rule, including opportunities for further standardization and burden reduction. The deadline to submit comments is February 21, 2026.