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Looking to 2022: How States are Approaching Price Transparency
by Sydney Edwards, JD 
January 26, 2022 As we head into 2022, there is a lot going on for health insurance plans. Price transparency mandates are in full swing, consumer demand for information and better digital experiences is rising, and additional regulations are being made at state levels that plans need to be aware of and prepare for.
As I’ve dug into price transparency over the past year and look ahead, I see a two-prong approach dominating 2022 for those health plans that hope to meet their members’ needs and the letter of the law.
- First, health plans have to be aware of what is going on from a legislative perspective in the states they operate in. This is an incredibly dynamic space at the moment.
- Second, health plans need to be focused on positioning themselves in relation to the Transparency in Coverage and No Surprises Act mandates this year, in order to leverage differentiation opportunities while maintaining flexibility for future rule developments at both the state and federal levels.
States are moving quickly toward price transparency
Federal and state rules related to price transparency are like a game of the tortoise and the hare. The federal government, our tortoise, is moving slowly and steadily forward with three phases and long feedback periods. Health plans need to be thinking through the long runway of compliance through 2024. But on the state level, you have the hare, and a much shorter timeline. In fact, a number of states nationwide have already codified certain aspects for federal transparency mandates. State-level policymaking is much more dynamic and new rules dictating how health plans provide price transparency could be introduced and go into effect within a single year.
Texas, for example, has HB-2090, which establishes an all-payer claims database and requires similar price transparency rules with publicly-available machine-readable files (MRFs) as the federal transparency rules. The big difference? The bill was introduced in April 2021, was signed by the Governor on June 7, 2021 and went into effect on September 1, 2021.South Dakota, Tennessee, Georgia, Ohio and others are codifying certain aspects of transparency with different time frames as well.
To act quickly, you must be prepared
Price transparency is a hot topic and one that is really seeing rapid changes at the state level. Health plans cannot lose sight of the fact that states can act very quickly in the best interest of their constituency, and particularly those states with an appetite for consumer protections.
Here are a few suggestions to ensure readiness for 2022 state legislative activity:
- Be aware of the opening and convening dates of state legislatures. Answer what the legislative session looks like for the year ahead.
- Review online tools to check the status of pending, open, or proposed legislation. Use Legiscan to search for information on the states you work in. Use the term “related to insurance” to see active or moving legislation in your state(s).
- Follow your governor’s website. They will talk about the things that matter to constituents. You can get a feel for what your governor cares about and you should be watching very closely if the things your governor cares about could impact insurance code.
Don’t lose sight of what’s ahead
Beyond monitoring the letter of the law nationally and in the states your plan operates in, you also need to have one eye on the future of how these laws can change and how your plan will stand out when many of your previous differentiators become the same services offered by competitors. Listen to your members and understand their needs to build your price transparency and online portal tools in ways that deliver on those. Engage in planning that not only focuses on the federal mandate timelines, but delivering those requirements as early, and with as much flexibility and focus on the member experience as possible.
We continue to monitor and provide insights for health plans on price transparency rules and enforcement dates. Our team is here to support you if you have any questions or need assistance in planning for compliance.