Plans, Payers Would Face Significant systems & Data Changes To Comply
February 21, 2026, is the deadline for health plan fiduciaries, sponsors, insurers, service providers and other concerned parties to comment on the Proposed Transparency in Coverage Rule jointly proposed by the Centers for Medicare & Medicaid Services (“CMS”), the Department of Labor (“DOL”), and the Department of the Treasury (collectively, the “Departments”) on December 19, 2025.
The Proposed Rule proposed to take effect in 2027 seeks to significantly revise the existing Transparency in Coverage rules currently applicable to health plans by reducing file complexity and size, making data clearer, and producing more usable information that consumers, employers, and innovators can rely on. If adopted as proposed, health plan and health insurers, their sponsors, fiduciaries and service providers will be required to implement the data, systems and consumer updates necessary to comply with the self-service internet-based tool provisions for plan years (in the individual market, policy years) beginning on or after January 1, 2027.
The 2020 Transparency in Coverage rules originally issued during the first Trump Presidency requires health plans and health care providers to share detailed pricing information.
Under current rules, non-grandfathered group health plans and health insurance issuers offering non-grandfathered group and 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, and a prescription drug file disclosing in-network rates and historic net prices for covered items and services. These requirements became applicable in July 2022.[1]
Since these rules took effect, health plans. And insurers have faced criticism for lax compliance with the 2020 Teansparency in Coverage Rules. Additionally, the rules themselves have been criticized for provisions that allow oversized files, duplicative data, unstandardized data information, and other issues to limit the use, accessibility and reliability of the data released under the original rule.
In line with Executive Order 14221, the newly proposed rule seeks to confront these barriers by simplifying how data is organized, eliminating unnecessary information, and making consumer-facing cost tools more accessible to more consumers by:
- Requiring plans and issuers to exclude from the In-network Rate Files certain data for services providers would be unlikely to perform.
- Reorganizing In-network Rate Files by provider network rather than by plan, cutting redundancy, and aligning with how most hospitals report data pursuant to the Hospital Price Transparency requirements.
- Requiring Change-log and Utilization Files so users can easily identify what has changed from one In-network Rate File to the next and have clear information on which in-network providers are actively furnishing which items and services.
- Reducing reporting cadence for In-network Rate and Allowed Amount Files from monthly to quarterly, significantly reducing burden while maintaining meaningful transparency.
- Increasing 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 increasing 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 would tighten requirements for health plan or issuer-provided price comparison tools by aligning them with consumer protections established under the No Surprises Act.
The proposed rule also will require group health plans and health insurance issuers to provide the same detailed cost-sharing information whether viewed online, or in print or provided by telephone, upon request.
The Departments aim for these changes to better equip employers, innovators, and researchers with the information they need to strengthen negotiations, identify cost drivers, and build new tools that help consumers shop for care with confidence by making pricing information more accurate, more accessible, and more actionable by improving clarity, accuracy, and providing better contextual information.
The proposed rules do not include major changes to prescription drug disclosure requirements, which the Departments say they intend to address separately.[1]
The Departments seek feedback from stakeholders during the 60-day comment period on all elements of the proposed rule, including opportunities for further standardization and burden reduction. The deadline to submit comments is February 21, 2026.
Health plan sponsors, fiduciaries, administrators, and other concern, people should timely review and submit comments. Employers and producers also should begin evaluating and preparing to adapt their existing plan documents, contracts, policies, and procedures to them impending rules. Because noncompliance with these rules also can have significant liability exposures, this is an excellent time for health plan sponsors, and fiduciaries to review and confirm the adequacy of their existing practices and documentation.
If you have questions about these health plan exposures or other health care, workforce employee benefits or other regulatory compliance or investigations concerns, contact the author.
More Information
We hope this update is helpful. For more information about the or other health or other employee benefits, human resources, or health care developments, please contact the author Cynthia Marcotte Stamer via e-mail or via telephone at (214) 452 -8297.
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About the Author
Cynthia Marcotte Stamer is a Martindale-Hubble AV-Preeminent (highest/top 1%) practicing attorney recognized as a “Top Woman Lawyer,” “Top Rated Lawyer,” and “LEGAL LEADER™” in Health Care Law and Labor and Employment Law; among the “Best Lawyers In Dallas” in “Labor & Employment,” “Tax: ERISA & Employee Benefits,” “Health Care” and “Business and Commercial Law recognized for her experience, scholarship, thought leadership and advocacy on health and other employee benefits, insurance, healthcare, workforce, HIPAA and other data and technology and other compliance in connection with her work with health care and life sciences, employee benefits, insurance, education, technology and other highly regulated and performance-dependent clients.
Board certified in labor and employment law by the Texas Board of Legal Specialization and a Fellow in the American College of Employee Benefits Counsel, Ms. Stamer has more than 35 years experience advisingemployers about these and other workforce, employee benefits, internal controls and other operations and compliance concerns.
Ms. Stamer is nationally recognized for her decades of leading-edge experience on the design, sponsorship, administration and defense of health and other employee benefit, workforce, insurance, healthcare, data and technology and other operations to promote legal and operational compliance, reduce regulatory and other liability and promote other operational goals.
Along with her decades of legal and strategic consulting experience, Ms. Stamer also contributes her leadership and experience to many professional, civic and community organizations. She currently serves as Co-Chair of the ABA Real Property Trusts and Estates (“RPTE”) Section Welfare Plan Committee, Co-Chair of the ABA International Section International Employment Law Committee and its Annual Meeting Program Planning Committee, Chair Emeritus and Vice Chair of the ABA Tort Trial and Insurance (“TIPS”) Section Medicine and Law Committee, and Chair of the ABA Intellectual Property Section Law Practice Management Committee. She also has served as Scribe for the Joint Committee on Employee Benefits (“JCEB”) annual agency meetings with the Department of Health and Human Services and JCEB Council Representative, International Section Life Sciences Committee Chair, RPTE Section Employee Benefits Group Chair and a Substantive Groups Committee Member, Health Law Section Managed Care & Insurance Interest Group Chair, as TIPS Section Medicine and Law Committee Chair and Employee Benefits Committee and Workers Compensation Committee Vice Chair, Tax Section Fringe Benefit Committee Chair, and in various other ABA leadership capacities. Ms. Stamer also is a former Southwest Benefits Association Board Member and Continuing Education Chair, SHRM National Consultant Board Chair and Region IV Chair, Dallas Bar Association Employee Benefits Committee Chair, former Texas Association of Business State, Regional and Dallas Chapter Chair, a founding board member and Past President of the Alliance for Healthcare Excellence, as well as in the leadership of many other professional, civic and community organizations. She also is recognized for her contributions to strengthening health care policy and charitable and community service resolving health care challenges performed under PROJECT COPE Coalition For Patient Empowerment initiative and many other pro bono service involvements locally, nationally and internationally.
Ms. Stamer is the author of many highly regarded works published by leading professional and business publishers, the ABA, the American Health Lawyers Association, and others. Ms. Stamer also often speaks and serves on the faculty and steering committee for many ABA and other professional and industry conferences and conducts leadership and industry training for a wide range of organizations.
For more information about Ms. Stamer or her health industry and other experience and involvements, see http://www.cynthiastamer.com or contact Ms. Stamer via telephone at (214) 452-8297 or via e-mail here.
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