On April 1, 2026, CMS will begin enforcing recent updates to its federal Hospital Price Transparency (HPT) regulations. The updated HPT regulations reflect CMS’s continued effort to transform hospital price transparency from a basic disclosure obligation into a more standardized and data-driven framework for health care pricing information.
Given upcoming scrutiny by CMS, hospitals would be well advised to ensure that they understand the updated regulations and have updated their HPT processes accordingly.
Background
Under section 2718 of the Public Health Service Act, hospitals are required to publicly disclose their standard charges by posting pricing information for items and services provided by the hospital. Effective January 1, 2021, CMS codified new regulations at 45 C.F.R. Part 180 to address these HPT requirements (HPT Rule). The HPT Rule requires hospitals to maintain and make public (i) a machine-readable file (MRF) that includes a comprehensive list of the hospital’s standard charges, including payer-specific negotiated rates, for all items and services provided by the hospital; and (ii) a consumer-friendly list of the hospital’s standard charges for a limited set of shoppable services. These requirements are intended to increase transparency in health care pricing, enabling consumers to compare care options and supporting more informed negotiations between hospitals and payers.
In February 2025, the White House issued Executive Order 14221 (the Executive Order), which called on HHS and certain other agencies to take all necessary and appropriate actions to (i) “require the disclosure of the actual prices of items and services, not estimates,” (ii) “ensur[e] pricing information is standardized and easily comparable across hospitals and health plans,” and (iii) “updat[e] enforcement policies designed to ensure compliance with the transparent reporting of complete, accurate, and meaningful data.”
In the CY 2026 OPPS Final Rule, CMS made significant revisions to the HPT Rule to meet those directives. Although the revised regulations became effective January 1, 2026, CMS stated that it would delay enforcing the new provisions until April 1, 2026, to allow hospitals a short transition period to update their MRFs and related compliance processes.
To facilitate that transition, CMS issued FAQs and conducted a webinar to review the new requirements and offer operational guidance to hospitals implementing the changes.
The key changes made to the HPT Rule are described below.
Expanded MRF Data Requirements Focused on Actual Prices, Not Estimates
The most significant revisions to the HPT Rule affect the data elements that hospitals must include in their publicly available MRFs.
Under the HPT Rule, hospitals are required to disclose payer-specific negotiated charges for items and services provided by the hospital. Notably, some payer-specific negotiated charges are not a set dollar amount, but instead are determined based on a percentage or other formula. In those situations, CMS originally required hospitals to report an “estimated allowed amount” reflecting the average historical payment received by the hospital for the item or service.
Consistent with the Executive Order’s directive to disclose “actual prices” and “not estimates,” CMS has replaced the estimated allowed amount with several data elements derived from historical payment experience. Specifically, under the revised HPT Rule, hospitals must now report the following data elements in their MRFs whenever a payer-specific negotiated charge is based on a percentage or other formula:
- Median allowed amount: median of the total allowed amounts the hospital has historically received from the third-party payer for an item or service over a 12-15 month lookback period;
- 10th percentile allowed amount: 10th percentile of the total allowed amounts the hospital has historically received from the third-party payer for an item or service over a 12-15 month lookback period;
- 90th percentile allowed amount: 90th percentile of the total allowed amounts the hospital has historically received from the third-party payer for an item or service over the last 12-15 month lookback period;
- Count of allowed amounts used to calculate those figures: total number of allowed amount remittances that were used to calculate the above allowed amounts.
Data Standardization Requirements
Consistent with the Executive Order’s goal of ensuring that data is “standardized and easily comparable across hospitals and health plans,” CMS also introduced several changes in the CY 2026 OPPS Final Rule intended to improve the standardization of hospital pricing data.
Under the HPT Rule, hospitals always have been required to report identifying information in the form of the hospital’s name, address, license number, and Employer Identification Number (EIN). According to CMS, industry members had informed the agency that these identifiers were “inadequate” to facilitate comparing hospital MRF data with other datasets and that a “standard identifier would bolster those efforts.” To that end, the updated HPT Rule now requires hospitals to include their organizational (Type 2) National Provider Identifier (NPI) in the MRF to facilitate cross‑dataset linkage and analysis.
Replacement of MRF Affirmation Statement with More Robust Attestation
CMS updated the HPT Rule on January 1, 2024 to require each hospital to “affirm” in its MRF that, “to the best of its knowledge and belief,” the hospital had “included all applicable standard charge information” in the MRF and that the data encoded therein was “true, accurate, and complete.” CMS added this affirmation statement requirement to lessen public confusion about whether a hospital’s standard charge information was accurate and complete and to “streamline” CMS enforcement of the HPT Rule.
To address the Executive Order’s goal of bolstering enforcement, CMS replaced the HPT Rule’s affirmation statement requirement with a more specific and nuanced attestation statement requirement. Under the CY 2026 Final Rule, each hospital must now “attest” in its MRF that, “to the best of its knowledge and belief”:
- the information contained in the hospital’s MRF is “true, accurate, and complete,”
- the hospital has “included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount,” and
- for payer-specific negotiated charges that “cannot be expressed as a dollar amount” in the MRF or are “not knowable in advance,” “the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount” and the hospital “has provided all necessary information available” to it “for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.”
CMS also added a requirement that the hospital must encode in the MRF the name of the hospital chief executive officer, president, or other senior official who is responsible for oversight of the data in the hospital’s MRF.
Since CMS added an affirmation statement in 2024, several industry members have expressed concerns that an affirmation or attestation in the MRF could expose hospitals to potential liability under the False Claims Act (FCA). In connection with the 2026 OPPS Final Rule, commenters requested that CMS specifically address those concerns by articulating specific reasons why non-compliance with the HPT Rule’s attestation requirement would not give rise to FCA liability or co-issuing a policy with DOJ stating that the agency would move to dismiss all FCA cases based on the HPT Rule’s attestation requirement. Unfortunately, CMS declined to adopt either suggestion, repeating the position taken in prior rulemakings that the FCA was “outside the scope” of the rulemaking at issue.
Opportunity for Reduction in Civil Monetary Penalties
Since the HPT Rule first went into effect, CMS has had the authority to impose civil monetary penalties (CMPs) on hospitals that failed to comply with HPT requirements. In the CY 2026 OPPS Final Rule, CMS adopted a policy to decrease CMPs by 35% in certain situations when a hospital waives its right to an ALJ hearing. Consistent with the Executive Order’s directive to improve enforcement, CMS created this opportunity for a CMP reduction to “encourage faster resolution and payment of CMPs.”
To qualify for the 35% CMP reduction, a hospital must submit a written notice to CMS requesting to waive its right to an ALJ hearing within 30 calendar days of the date of the notice of imposition of a CMP. However, CMS will not afford hospitals the opportunity to have a CMP reduction where a CMP was imposed on a hospital for “noncompliance going to the core of the HPT requirements.” Namely, CMS will decline to make this option available to a hospital that fails to make public either an MRF or a consumer-friendly list of standard charges for shoppable services.
Additionally, a hospital will not be eligible for the 35% CMP reduction for any subsequent CMPs imposed for continued noncompliance with the HPT Rule.
Implications
The regulatory updates to the HPT Rule fit within a broader federal transparency initiative affecting multiple segments of the health care system. Over the past several years, federal policymakers have implemented parallel transparency requirements for health plans and issuers under the Transparency in Coverage (TiC) rules and for providers and facilities under the No Surprises Act (NSA). For example, the TiC rules require group health plans and issuers to publish machine-readable files disclosing in-network negotiated rates and historical out-of-network allowed amounts, while the NSA requires providers and facilities to furnish good faith estimates of expected charges to uninsured and self-pay patients in certain circumstances. Together, these regulatory regimes reflect a continuing federal effort to increase price transparency across both provider and payer markets, with the goal of improving consumer access to meaningful health care cost information and facilitating price comparison tools.
With enforcement of the updated HPT Rule beginning April 1, 2026, hospitals should review their transparency compliance programs now to ensure that their MRFs reflect the updated regulatory requirements and that the underlying pricing data can withstand potential CMS scrutiny.
