The modern movement for hospital price transparency began as a bipartisan response to frustration among patients and employers who could not determine what medical care would actually cost. During the 2010s, national business groups and consumer advocates pushed for open pricing data, arguing that opaque billing practices shielded hospitals and insurers from competition. The legal foundation for today’s requirements comes from Section 2718(e) of the Public Health Service Act, codified at 42 U.S.C. § 300gg-18(e) and enacted as part of the Patient Protection and Affordable Care Act of 2010. That provision directed the Secretary of Health and Human Services (HHS) to require hospitals to make their standard charges public, although for almost a decade the mandate saw little enforcement.

The first major action came from the first Trump administration in 2019, when an executive order directed HHS, the Treasury, and the Department of Labor to require hospitals and insurers to disclose pricing information. This order led to the Hospital Price Transparency Rule, finalized in late 2019, which required hospitals to begin posting detailed pricing data on January 1, 2021. The Biden administration later expanded enforcement beginning in 2022 by increasing penalties and formalizing data templates to promote consistency. Now, during President Trump’s second term, the administration has renewed the initiative, directing agencies to tighten compliance, standardize data, and move toward disclosure of actual prices, while CMS’s 2024–25 updates require estimated allowed dollar amounts when percentage or algorithmic methods are used. What began as a brief statutory provision in 2010 has become a comprehensive regulatory framework that now governs how each hospital—including those in Mississippi—must disclose its prices to the public.

Mississippi hospitals, like all hospitals nationwide, must comply with two separate online disclosure requirements that contain strict technical specifications. Each hospital must post a single machine-readable digital file that computers can process automatically for analysis or download. The regulation defines “machine readable” as a single digital file—such as a comma-separated values (CSV) or JavaScript Object Notation (JSON) file—that can be directly imported and read by a computer without manual entry or conversion. This allows automated systems to identify, extract, and compare pricing information across hospitals. The file must follow the Centers for Medicare & Medicaid Services (CMS) template and data dictionary, be searchable, and include metadata such as the hospital’s name, license number, all covered locations, the template version, and the date last updated.

Hospitals must also post a consumer-friendly display listing at least 300 shoppable services—or all services if fewer—or operate a compliant online price estimator. A hospital’s “standard charge” is its established rate for a particular item or service, and it must include five specific data elements:

1. the gross charge listed on the chargemaster;
2. the payer-specific negotiated charge linked to each payer and plan;
3. the de-identified minimum negotiated charge;
4. the de-identified maximum negotiated charge; and,
5. the discounted cash price offered to a patient who pays in cash or equivalent.

Every item and service in the machine-readable file must include all five standard charge types, while the shoppable service display must include the payer-specific negotiated charge and the discounted cash price (or the gross charge if no discounted cash price is available). Beginning July 1, 2024, hospitals must use the CMS template, and beginning January 1, 2025, they must also include an estimated allowed dollar amount whenever a standard charge is expressed as a percentage or algorithm.

CMS enforces these requirements through a structured process set out in 45 C.F.R. §§ 180.70, 180.80, 180.90, and 180.110. The agency monitors hospital websites, conducts audits, and reviews complaints. When CMS identifies possible violations, it first sends a warning notice identifying deficiencies and requiring acknowledgment. If the problems continue, CMS issues a notice of violation directing the hospital to submit a corrective action plan (CAP) by the deadline specified in the notice of violation, typically within 45 to 90 days. CMS reviews the CAP, may approve or request revisions, and monitors its completion. If the hospital fails to respond or implement the CAP on time, CMS imposes a civil monetary penalty (CMP) and posts the penalty notice publicly. The notice triggers a 30-day window for the hospital to request a hearing before the HHS Departmental Appeals Board. If no hearing is requested, appeal rights are waived. Once upheld, the penalty must be paid within 60 days.

Most enforcement findings involve technical or posting errors. The machine-readable file must comply with CMS’s naming convention, and the hospital must host a plain-text locator file at the root of its website listing the transparency page URL, a direct link to the pricing file, and a contact point for questions. The website must also include a footer link labeled “Price Transparency” that takes users directly to the pricing page. Hospitals must update both disclosures at least once each year and include a statement in the machine-readable file affirming that the information is complete and accurate as of the date listed. The shoppable display must include all required data fields for each service and be searchable by description, billing code, and payer. These items are simple for CMS to check, and failure to meet them is one of the fastest ways to trigger a penalty.

Recent enforcement actions demonstrate that hospitals of every type — public or private, for-profit, nonprofit, or governmental, and of every size, from large urban systems to small rural facilities — have faced substantial financial penalties for missing even minor technical requirements.

• In July 2024, CMS imposed an $871,122 civil monetary penalty on Jackson Memorial Hospital, a public hospital in Miami, Florida, owned and operated by the Public Health Trust of Miami-Dade County. CMS found that, even after an approved corrective action plan, the hospital still lacked the required root-level text locator file, the “Price Transparency” footer link, and a compliant consumer-friendly list of shoppable services. As one of the nation’s largest hospitals—with well over 550 licensed beds—Jackson Memorial fell under the highest daily penalty cap for large hospitals. Under 45 C.F.R. § 180.90, CMS assesses a per-bed, per-day penalty of $10 (adjusted annually for inflation under 45 C.F.R. Part 102), capped at $5,500 per day for hospitals with more than 550 beds. By 2024, that cap had risen to $5,926 per day. Using the hospital’s most recent Medicare cost report, CMS confirmed that Jackson Memorial exceeded the 550-bed threshold and remained noncompliant for 147 days, resulting in a total penalty of $5,926 × 147 days = $871,122.

• In February 2025, CMS imposed a $75,582 penalty on Bucktail Medical Center, a rural critical-access hospital in Renovo, Pennsylvania, owned by a private nonprofit organization, after repeated reviews found no machine-readable file, no shoppable-services display, no root-level locator file, and no footer link. Under 45 C.F.R. § 180.90, hospitals with 30 or fewer beds are subject to a flat daily rate of $323 (the inflation-adjusted rate), while larger hospitals are charged $11 per bed per day, up to a maximum annual penalty of $2,007,500. CMS calculated $323 × 234 days = $75,582, noting that earlier warnings from 2023 and 2024 documented the hospital’s continued failure to implement the required corrections.

• In March 2025, CMS fined Northlake Behavioral Health System, a private nonprofit psychiatric hospital in Mandeville, Louisiana, $257,180 for template and metadata violations, missing de-identified minimum and maximum negotiated charges, and missing payer names in its shoppable display. Using the same formula under 45 C.F.R. § 180.90, CMS multiplied $11 × 140 beds × 167 days = $257,180. The notice explained that the calculation covered the period from CMS’s first finding of violation until verification that the hospital was in compliance.

• In May 2025, CMS imposed a $309,738 penalty on Arkansas Methodist Medical Center, a private nonprofit hospital in Paragould, Arkansas, after multiple reviews found ongoing noncompliance. CMS cited the absence of the root locator file and footer link, the lack of the required affirmation statement, failure to follow the CMS data dictionary, omission of hospital identity and location metadata, and failure to update data annually. CMS calculated $11 × 114 beds × 247 days = $309,738, applying the inflation-adjusted per-bed, per-day rate for hospitals with more than 30 beds under 45 C.F.R. Part 102.

For Mississippi hospitals, the lessons are clear. Each hospital should confirm that it maintains a single CSV or JSON file that follows the CMS template and naming conventions, includes all five standard charge types for every item and service, encodes the required metadata, and is linked through both the root-level text locator file and the “Price Transparency” footer link. The shoppable display must cover at least 300 services and include all five standard charge types for each, searchable by description, billing code, and payer. Hospitals should maintain a documented annual update process and promptly respond to any CMS correspondence by submitting a complete corrective plan within the required timeframe.

Compliance with these requirements is no longer optional. As federal policy continues to make transparency a central feature of healthcare regulation—from the first Trump administration’s 2019 executive order to the renewed enforcement emphasis of the second Trump administration—Mississippi hospitals must treat their online pricing data as an active, ongoing compliance responsibility. The difference between a clean CMS review and a public penalty notice now depends on whether those online files are accurate, correctly linked, and regularly updated. 

Wise Carter has extensive experience advising hospitals and health systems on compliance with federal price transparency requirements, including the preparation of machine-readable files, shoppable service displays, and responses to CMS audits and enforcement actions. The firm regularly assists healthcare providers with all aspects of regulatory compliance, from day-to-day operational questions to complex investigations, ensuring clients remain fully aligned with evolving CMS guidance and broader healthcare regulatory obligations. If your organization needs assistance with price transparency compliance or any other healthcare regulatory matter, Wise Carter can help.