The Centers for Medicare and Medicaid Services has announced changes to its enforcement of the Hospital Price Transparency rule. If hospitals fail to submit a Corrective Action Plan (CAP) on time or fail to complete the CAP in 45 days, they will, without notice, have a civil monetary penalty imposed.
Why is this change important?
CMS will no longer issue a warning notice to hospitals that have not posted a fully compliant machine-readable file or a consumer-friendly website of 70 shoppable services and they will immediately ask the hospital to submit a CAP.
Click here to read more about the CMS enforcement update.
Warning letters and CAPs – What's the difference?
Warning Letters are notices to Hospitals that identify an area of unacceptable performance along with a request to remedy the situation.
Corrective Action Plans are issued when CMS has identified an area of concern that requires a formal plan for a demonstrated cure. Hospitals that receive Corrective Action Plans have a specific and limited period of time to respond. Further considerations regarding CAPs include:
- CMS will not release organizations from CAPs until the agency receives verifiable evidence that the non-compliance in question was resolved.
- CMS will not consider the issue resolved until the CAP is both accepted and released.
- Acceptance of the CAP means CMS has determined that an organization's proposed course of action to resolve a matter is acceptable.
- Release from the CAP involves CMS determining that the organization's CAP was implemented and that demonstrable interventions aimed at resolving an area of non-compliance were successful.
- Failure to close out a CAP successfully and timely may result in further compliance activity, which may include sanctions, civil money penalties, or contract termination. CAPs are publicly reported via the Internet.
What to do next
Please contact the price transparency experts at ClaraPrice if you need help ensuring that your facility is meeting the compliance requirements. The team of Revenue Cycle and Compliance experts at ClaraPrice will also ensure your hospital’s pricing remains consistent across price transparency, good faith estimates, and all requirements of the No Surprises Act.