States have an important role to play in boosting price transparency compliance for both hospitals and health plans, two Georgetown University McCourt School of Public Policy research professors said in a Sept. 12 article for Health Affairs.
The article was written by Maanasa Kona, an assistant research professor and faculty member at the school's Center on Health Insurance Reforms, and Sabrina Corlette, research professor and co-director of the Center on Health Insurance Reforms.
The pair highlighted a recent law enacted in Colorado that prohibits hospitals from pursuing medical debt collections from patients if the hospital is not compliant with the federal price transparency rules. Noncompliant hospitals are also barred from suing patients or reporting the patient to a credit reporting agency. Patients are given the right to file a lawsuit against noncompliant hospitals if they receive a collection action.
They said that many states "may not even need such a direct legislative mandate" to enforceme hospital price transparency requirements. They said states are responsible for licensing hospitals and have significant leverage during that process to assess whether a hospital is complying with transparency requirements.
"States can also use their contracting power as the purchaser of healthcare coverage, whether through the state employee health plan, Medicaid, or state-based marketplaces, to require all downstream service providers, including hospitals, to be in full compliance with federal law," they wrote.
They said state insurance departments have oversight over insurers: They can require insurers to show they are compliant during the annual rate review process, review payer data to confirm compliance, issue their own rules and guidance on improving data accessibility, create easy-to-use reporting templates, and hold plans accountable for not being in compliance.