Transparency in Coverage Final Rules (CMS 9882-F)

Marketplace Share Transparency in Coverage Final Rules (CMS 9882-F) Introduction Consistent with the President’s Executive Order 14221 , “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information,” on October 5, 2026, the Department of Health and Human Services (through the Centers for Medicare & Medicaid Services), in partnership with the Departments of Labor and the Department of the Treasury (collectively, the Departments) jointly finalized changes to the Transparency in Coverage regulations to improve the accessibility of pricing disclosures to participants, beneficiaries, and enrollees, and the standardization and reliability of the public pricing disclosures from non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage. These changes build on the historic disclosure requirements the Departments issued in the Transparency in Coverage final rules on Nov. 12, 2020 (the 2020 final rules) in line with the President’s June 24, 2019, Executive Order (EO) 13877, “Improving Price and Quality Transparency in American Healthcare to Put Patients First” and EO 14221, “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information.” This fact sheet discusses the provisions of the Transparency in Coverage final rules (CMS-9882-F) that amend the 2020 final rules. You can access the final rules in the Federal Register at: https://www.federalregister.gov/public-inspection/2026-20447/transparency-in-coverage Under the 2020 final rules, non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage are required to post machine-readable files monthly for each plan or coverage they offer — an in-network rate file disclosing in-network rates for all covered items and services, an allowed amount file disclosing out-of-network allowed amounts and the associated billed charges for covered items and services, and a prescription drug file disclosing in-network rates and historical net prices for covered prescription drugs. These requirements became applicable in July 2022. 1 Improved Standardization, Accuracy, and Accessibility of the In-Network Rate and Out-of-Network Allowed Amount Machine-Readable Files Based on internal assessment and external stakeholder feedback received since implementation began, the Departments have identified three main barriers to fully achieving the goals of the 2020 final rules: inaccessibility due to the large size of the machine-readable files, data ambiguity due to lack of contextual information alongside the raw data, and areas of misalignment with the Hospital Price Transparency rule that make comparing data across disclosures challenging. Reducing the Number and Size of Machine-Readable Files and Increasing Accessibility to Make Data More Meaningful A major driver of large in-network rate file sizes involves including provider-negotiated rates for items or services the provider is unlikely to furnish because of their specialty and the nature of the item or service (e.g., rates for podiatrists to perform heart surgery). This occurs because payer-provider contracts often negotiate rates at the provider organization level for every provider who is a member of the organization, regardless of clinical specialty. To address these unlikely provider-rate combinations, the final rules include amendments to: Require group health plans and health insurance issuers to exclude from their In-network Rate Files provider-rate combinations for items and services that providers would be unlikely to be reimbursed for given that provider’s specialty area. The provision requires plans and issuers to determine which provider-rate combinations to exclude by using their internal provider taxonomies or other internal rules used during the claims adjudication process to determine if the provider should be reimbursed for the item or service given that provider's specialty; Post the internal provider taxonomy mapping or other rules they used to prepare each In-network Rate File in a new file called the Taxonomy File; and Post a new file called a Utilization File for each In-network Rate File, which will include all providers who have submitted and received reimbursement for at least one claim for a covered item or service for the most recent plan or policy year ending six months before the posting of the file. To reduce duplicative data, the Departments finalized a change to the level at which group health plans and health insurance issuers must report data in the In-network Rate File. Under this provision, plans and issuers must prepare one In-network Rate File for each provider network they maintain or contract with, rather than for each plan or policy they offer, as required by the 2020 final rules. Because it is very common for multiple plans of