Regulations and Guidance
- Transparency in Coverage Final Rules
- Transparency in Coverage FAQs
Resources
- Link to GitHub technical specifications for machine readable files
Explore technical implementation examples and participate in development discussions. - Link to GitHub validator for the machine readable files
Download a validator tool to verify your machine readable files - 8-Steps to build the In-Network Rates and Allowed Amounts machine readable files (PDF)
- Webinars
Enforcement
The Public Health Service Act (PHS Act) provides that States will exercise primary enforcement authority over health insurance issuers in the group and individual markets to ensure compliance with the health insurance market reforms. If a state informs CMS that it does not have authority to enforce one or more of the applicable provisions of the PHS Act, and the state has not entered into a collaborative enforcement agreement (CEA), CMS has the responsibility to directly enforce the relevant provisions in the state with respect to health insurance issuers in the group and individual markets. Under a CEA, the state agrees to seek voluntary compliance from health insurance issuers and refer to CMS for possible enforcement action any potential violation for which the state is not able to obtain voluntary compliance. The below chart captures the Transparency in Coverage Final Rule requirements that each state is enforcing either directly or through a CEA, and the requirements that CMS is enforcing.
State | Machine-Readable Files | Price Comparison Tool |
|---|---|---|
| Alabama | CMS | CMS |
| Alaska | CMS | CMS |
| Arizona | CMS | CMS |
| Arkansas | CMS | CMS |
| California | CMS | CMS |
| Colorado | State | State |
| Connecticut | State (CEA) | State (CEA) |
| Delaware | CMS | CMS |
| District of Columbia | State | State |
| Florida | CMS | CMS |
| Hawaii | CMS | CMS |
| Idaho | State | State |
| Illinois | CMS | CMS |
| Indiana | CMS | CMS |
| Iowa | CMS | State |
| Kansas | State | State |
| Kentucky | CMS | State |
| Louisiana | CMS | CMS |
| Maine | State | State |
| Maryland | State (CEA) | State (CEA) |
| Massachusetts | State (CEA) | State |
| Michigan | CMS | State |
| Minnesota | CMS | CMS |
| Mississippi | State (CEA) | State (CEA) |
| Missouri | CMS | CMS |
| Montana | CMS | CMS |
| Nebraska | CMS | CMS |
| Nevada | State | State |
| New Hampshire | State | State |
| New Jersey | State (CEA) | State (CEA) |
| New Mexico | CMS | CMS |
| New York | CMS | State |
| North Carolina | CMS | CMS |
| North Dakota | State | State |
| Ohio | CMS | CMS |
| Oklahoma | CMS | CMS |
| Oregon | CMS | CMS |
| Pennsylvania | State (CEA) | State (CEA) |
| Rhode Island | CMS | CMS |
| South Carolina | State (CEA) | State (CEA) |
| South Dakota | State (CEA) | State (CEA) |
| Tennessee | CMS | CMS |
| Texas | CMS | CMS |
| Utah | State | State |
| Vermont | State | State |
| Virginia | CMS | CMS |
| Washington | CMS | CMS |
| West Virginia | State | State |
| Wisconsin | CMS | State (CEA) |
| Wyoming | CMS | CMS |