Compliance News Week Ending May 30, 2025

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Transparency Updates

Congressional Research Service Report - Preventive Coverage

Transparency Updates

Federal agencies recently provided new guidance and requests for information to strengthen the implementation and enforcement of healthcare transparency rules as directed by the president's Executive Order.

This does not change anything specific to employer compliance obligations but has the potential to provide further access to healthcare spend data.

Machine-Readable Files - The Departments of Labor, HHS, and Treasury introduced Schema Version 2.0 for machine-readable files under the Transparency in Coverage Final Rule, aiming to reduce file size and improve clarity by eliminating duplicative data. In addition, an RFI was issued to gather input on prescription drug machine-readable files, which are currently delayed pending further guidance. The RFI focuses on implementation challenges and potential alternatives and suggests regulations to implement the prescription drug portion of the machine-readable files’ requirement are in the works.

Hospital Price Transparency - CMS issued updated guidance for hospitals, requiring actual dollar amounts in pricing files instead of estimates. CMS also issued an RFI to gather input on how to increase compliance and ensure that accurate and complete data is shared.

Congressional Research Service Report – Preventive Coverage

Last week, the Congressional Research Service (CRS) released a report detailing the current federal framework for preventive health services coverage.

Under the Affordable Care Act (ACA), most group health plans must cover preventive services (e.g., immunizations, cancer screenings, and contraception) without cost-sharing based on recommendations from several federal agencies.

The report also explores the potential impact of ongoing litigation, including Braidwood v. Becerra, which challenges the ACA’s preventive mandate and could affect what group health plans are required to cover without cost-sharing.

CRS emphasizes how these federal requirements intersect with public programs and payment systems, shaping the broader landscape of preventive care access.

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