Response to comment document

Centers for Medicare and Medicaid Services Response to Public Comments Received for
CMS-10707/OMB control number # 0938-1369
The Centers for Medicare and Medicaid Services (CMS) received 17 public submissions from
consumer and patient advocacy organizations, professional trade associations, hospitals and
hospital associations on the Hospital Price Transparency Information Collection Requests (CMS10707, OMB 0938-1369) issued in the CY 2026 OPPS/ASC proposed rule (90 FR 33476)
(07/17/2025).
We combined the public submissions into 1 aggregated comment and provided response in the
document below.
Comment: While many commenters indicated that our proposed changes to the HPT
requirements outlined in the CY 2026 OPPS/ASC proposed rule and/or the HPT requirements in
general are burdensome, as discussed in prior sections of the final rule with comment period,
only several commenters commented on our specific burden estimates for these information
collections. Several commenters stated that CMS’s projected annual burden estimate was
underestimated, noting an undefined, but “significantly higher” burden and cost to implement the
proposed policies. A few commenters stated that hospitals that contract with outside vendors or
consultants to update their MRFs on an annual basis, do so at a cost of $10,000 to $30,000 per
hospital and those without vendor support report needing 5 to 30 full-time-equivalents (FTEs) to
update their MRFs on an annual basis. One commenter indicated that they recently updated their
MRF to meet the annual update requirement and it required 5 times the amount of hours CMS
estimated for the annual burden estimates. One commenter indicated that hospitals incur annual
vendor fees of up to $250,000 to update their MRFs and that even with vendor support, hospitals
may have 3 FTEs spend an entire month developing and validating their MRFs.
Similarly, several commenters indicated that CMS’ one-time burden estimate to encode the new
data elements in the MRF as proposed in the CY 2026 OPPS/ASC proposed rule was
underestimated. A few commenters maintained that they expect to spend $20,000-$30,000 to
elicit vendor support to encode the new data elements in the MRF by the January 1, 2026,
effective date proposed in the CY 2026 OPPS/ASC proposed rule. One commenter indicated
they believe they will need to spend thousands of dollars per hospital to hire a third-party vendor
or devote an internal “project management team” to support the encoding of the new data
elements. One commenter incorrectly stated that we estimated a one-time burden estimate of 20
hours to implement the new HPT requirements, at a cost of $1,598.90, and that this estimate
significantly understated the real cost of implementing the proposals. One commenter indicated
they had already spent more than the cost of the entire one-time burden estimate in just
reviewing the proposed rule.
Response: We appreciate commenters' concerns and the varying range of estimates provided by
commenters suggests that hospitals have different operational and administrative processes and
systems that impact the projected burden of encoding the new data elements and meeting the
requirement to update the MRF annually. To address this variability, we allow hospitals to
choose which CMS MRF template format they use, providing hospitals some flexibility to select
the least burdensome format and layout to develop and update their MRF. We expect that, as
indicated in the CY 2026 OPPS/ASC proposed rule, more than a year after the implementation of

the CMS MRF standard template, some hospitals have well developed automated processes in
place that they leverage to minimize the burden associated with making hospital standard charge
information public in their current MRFs. Additionally, as discussed in more detail in prior
sections of this final rule with comment period and as with previous HPT rulemaking, we will
provide technical guidance and examples of how to encode the new data elements we are
finalizing in this rule on the CMS Hospital Price Transparency – Data Dictionary GitHub
Repository, as well as guidance on the HPT resources page on the CMS website to further
minimize the burden to hospitals.
Moreover, in order to further reduce burden, as discussed in more detail in prior sections of the
final rule with comment period, we are delaying enforcement of our requirements to encode the
new data elements in the MRF. Specially, we are finalizing at § 180.50, the removal of the
estimated allowed amount, disclosure of the 10th percentile, median, 90th percentile allowed
amounts and the count of allowed amounts, the attestation requirements, and the requirement to
encode hospital NPIs effective January 1, 2026. However, we will delay enforcement of these
finalized revisions until April 1, 2026. We believe this 3-month enforcement delay will provide
hospitals with sufficient additional time to encode the new data elements and review their MRFs
prior to making them public online.
We continue to believe that increased standardization and comparability of the MRFs benefit
consumers of the MRF, and that this benefit outweighs the burden imposed by these
requirements. However, we are swayed by commenters that suggested we underestimated the
one-time burden of encoding the new data elements in the MRF. Therefore, we have increased
the one-time burden estimate for the General and Operations Manager and Business Operations
Specialist labor categories by doubling those estimates in this final rule with comment period.
Additionally, we have also added one-time and annual burden estimates for Chief Executives in
response to comments on the “Modification to the MRF Affirmation Statement” section of the
CY 2026 OPPS/ASC proposed rule, addressed in an earlier section of this final rule with
comment period, that suggested we failed to account for the burden for the hospital chief
executive officer, president, or senior official designated to oversee the encoding of true,
accurate, and complete data in the MRF to review and attest to the information. However, we
have retained our existing annual burden estimates for the General and Operations Manager and
Business Operations Specialist labor categories as we believe it is reasonable to assume that the
burden to hospitals for encoding the new data elements finalized in this rule will lessen with
subsequent annual updates to the MRF once hospitals have developed standardized processes
and procedures for doing so such that increasing the annual burden estimates for these labor
categories is unnecessary.
Final Action: After consideration of public comments, we are increasing both our one-time and
annual burden estimates. To implement the encoding of the new data elements we are finalizing
in the final rule with comment period, we now estimate that it will take a Business Operations
Specialist (BLS 13-1000), on average, 8 hours (at a cost of $87.52 per hour) to develop and
update the necessary processes and procedures and develop the requirements to implement the
proposed data elements and a General and Operations Managers (BLS 11-1021), on average, 2
hours (at a cost of $128.00 per hour) to review the updates, and a Chief Executive (BLS 111011) 2 hours (at a cost of $252.82) to review and attest to the accuracy and completeness of the
data in the MRF. Therefore, we believe the one-time burden estimate to be 88,992 hours for all

hospitals (12 hours × 7,416 hospitals) at a cost of $10,840,708.80 (7,416 hospitals × [($87.52 × 8
hours) + ($128.00 × 2 hours) + ($252.82 × 2 hours]); see Table 1.
TABLE 1: SUMMARY OF ONE-TIME BURDEN FOR THE INFORMATION
COLLECTIONS IN THE CY 2026 OPPS/ASC FINAL RULE
Regulation
section
§ 180.50

OMB
control
no.
09381369

Number of
respondents
7,416

Number of
responses

Burden
per
response
(hours)

Total
annual
burden
(hours)

Total labor cost
of reporting ($)

7,416

12

88,992

$10,840,708.80

Additionally, we still estimate it will take a General and Operations Manager (BLS 11-1021), 2
hours (at a cost of $128.00 per hour) per hospital to review and determine updates in compliance
with requirements. We still estimate the ongoing time for a Business Operations Specialist (BLS
13-1000), to be 40 hours (at a cost of $87.52 per hour) per hospital, to identify and gather the
required data elements on an annual basis. We still estimate that it will take a Computer System
Administrator (BLS 15-1244) 12 hours (at a cost of $97.30 per hour). to maintain and post the
MRF in a manner that conforms to the CMS standard template. However, we now estimate it
will take a Chief Executive (BLS 11-1011) 2 hours (at a cost of $252.82) to review and attest to
the accuracy and completeness of the data in the MRF prior to posting the MRF online, which
now brings the total burden per hospital to 56 hours. Therefore, we estimate a total annual
burden of 415,296 hours for all hospitals (7,416 hospitals × 56 hours) at a cost of $40,269,176.60
(7,416 hospitals × [($128/hour × 2 hours) + ($87.52/hour × 40 hours) + ($97.30/hour × 12 hours)
+ ($252.82/hour × 2 hours]); see Table 2.
TABLE 2: SUMMARY OF ANNUAL BURDEN FOR THE INFORMATION
COLLECTIONS IN THE CY 2026 OPPS/ASC FINAL RULE
Regulation
section
§ 180.50

OMB
control
no.
09381369

Number of
respondents
7,416

Number of
responses

Burden
per
response
(hours)

Total
annual
burden
(hours)

Total labor cost
of reporting ($)

7,416

56

415,296

$40,269,176.60