The Trump Administration’s first Unified Agenda, published in early September, lays out an ambitious regulatory calendar for commercial health plans — especially in the area of price transparency. The roadmap offers early insight into how the administration plans to shape healthcare policy in the months ahead.
I. What Is the Unified Agenda — and Why Is This One a Surprise?
The Unified Agenda (UA) is a semiannual publication put out by the federal government that lists proposed and final rules expected from federal agencies over the coming year. While publication dates can often shift, the Agenda serves as a public roadmap for an administration’s policy priorities.
Why this UA is surprising:
The administration had previously signaled a deregulatory stance, including a “one-in, ten-out” rule outlined in the President’s Executive Order on “Unleashing Prosperity Through Deregulation” (14192).
Yet, the current Agenda includes several impactful healthcare policies, including:
- No Surprises Act (NSA)
- Transparency in Coverage (TiC)
- Interoperability standards
- Standardized electronic transactions such as claims attachments, electronic funds transfers (EFT) and electronic remittance advice (ERA).
II. Transparency in Coverage Rule Expected September 2025
Among the most notable entries in the UA is a proposed rule on Transparency in Coverage (TiC), scheduled for publication in September 2025.
The rule is currently under final review by the Office of Management and Budget (OMB), suggesting that CMS has concrete policy ideas for price transparency and it intends to move on them quickly.
III. What Might Be in the Proposed Rule?
CMS has not released formal details about the contents of the upcoming TiC regulation. However, recent guidance and industry commentary point to several likely components:
Increased Enforcement and Penalties
CMS has ramped up audits and issued requests for information (RFIs) to improve compliance with price transparency rules. This could lead to higher penalties for non-compliant plans, echoing proposals like Congress’ “Patients Deserve Price Tags” Act which would authorize penalties of up to $10,000 a day for noncompliance.
Tightened Definition of “Estimate”
CMS recently updated guidance to require hospitals to use actual dollar amounts in machine-readable files (MRFs), replacing placeholder codes. A similar standard could apply to online cost estimator tools, pushing for more accurate and consistent pricing data.
Bundled Shoppable Services
There’s some momentum behind requiring plans to present bundled pricing for common services — grouping related CPT codes into packages to simplify the consumer experience.
Codifying TiC and (maybe) Schema 2.0
CMS is preparing to roll out Schema Version 2.0 for MRFs, with a finalized format expected by October 1, 2025, and enforcement beginning February 2026. Codifying this schema in regulation would standardize data formats and improve usability across the industry.
Final Thoughts
The Unified Agenda and the February 2025 Executive Order on healthcare price transparency reflect a clear policy shift toward greater transparency. Whether through enforcement, technical updates or new consumer protections, CMS appears committed to advancing the Transparency in Coverage framework.
Health plans should prepare now — not just for compliance, but to use transparency as a strategic advantage in pricing, contracting and consumer engagement.
