Departments Issue Proposed Rule on Transparency in Coverage; Comments Due February 21
Published December 22, 2025
The Centers for Medicare & Medicaid Services (CMS), the Department of Labor (DOL) and the Department of the Treasury (collectively, the Departments) jointly released a proposed rule amending the Employee Retirement Income Security Act of 1974 (ERISA) and the Internal Revenue Code (IRC) regarding price transparency reporting requirements for non-grandfathered group health plans and health insurance issuers offering non-grandfathered group and individual health insurance coverage.
The proposed rule:
- Requires plans and issuers to exclude from the in-network rate files certain data that services providers would be unlikely to perform.
- Reorganizes in-network rate files by provider network rather than by plan, aligning with how most hospitals report data on price transparency requirements.
- Requires change-log and utilization files so users can easily identify the changes from one in-network rate file to the next and have clear information on the items and services in-network providers are submitting.
- Reduces reporting requirements for in-network rates from monthly to quarterly.
- Increases 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 increases the reporting period from 90 days to 6 months and the lookback period of data from 180 days to 9 months.
Additionally, to ensure that every individual can access accurate, personalized health care pricing information in the way that works best for them, the proposed rule strengthens requirements for plan or issuer-provided price comparison tools by aligning them with consumer protections established under the No Surprises Act. Under the proposed rules, group health plans and health insurance issuers would be required to provide the same detailed cost-sharing information whether viewed online, or in print or provided by telephone, upon request. Updated disclosures will take into account new federal protections against balance billing under the No Surprises Act that help patients understand their rights and potential financial responsibilities before they seek care.
The proposed rule does not include major changes to prescription drug disclosure requirements, which the Departments intend to address separately.
The proposed rule amends the 2020 final rules.
Comments are requested by February 21, 2026.