HHS Finalizes Updates to the Transparency in Coverage Rule

Recently, the U.S. Department of Health and Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS) finalized changes to the Transparency in Coverage regulations to improve access to pricing information for participants, beneficiaries, and enrollees while enhancing the standardization and reliability of public pricing disclosures by non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual coverage. These changes are in line with the goals of Executive Order 14221, “Making America Healthy Again by Empowering Patients With Clear, Accurate, and Actionable Healthcare Pricing Information.”

With respect to the In-network Rate and Out-of-network Allowed Amount machine-readable files, this final rule adds new contextual files and additional data elements like product type, provider network name, and provider network identifier. Additionally, this final rule changes the reporting level for aggregation of data; removes in-network rates for unlikely provider-to-service mappings; increases the reporting period and lowers the claims threshold for out-of-network historical data; and reduces the reporting cadence.

This final rule also aims to improve the findability of all publicly disclosed machine-readable files required under the Transparency in Coverage rules, including the prescription drug file, by requiring a text file containing contact information for the files, and a footer with website URLs.

Additionally, the final rule requires pricing information that is made available through an online consumer tool and on paper (upon request), to also be made available by phone, and establish that the satisfaction of such requirement also satisfies the requirements of section 114 of the No Surprises Act (including for grandfathered group health plans and health insurance issuers offering grandfathered group and individual health insurance coverage that are not otherwise subject to these final rules).

This final rule takes effect on December 7, 2026, with different provisions subject to different compliance dates.

For more information, please review these resources:

• Final Rule Published in the Federal Register: https://www.federalregister.gov/documents/2026/10/06/2026-20447/transparency-in-coverage
• HHS Press Release: https://www.hhs.gov/press-room/cms-finalizes-healthcare-price-transparency-rules.html
• CMS Press Release: New Regulations Make It Easier to Find, Compare, and Report Healthcare Pricing and Coverage Information | CMS
• CMS Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/transparency-coverage-final-rules-cms-9882-f