(The Hill) — More than two years after federal hospital price transparency rules went into effect, only about a third of hospitals are currently in compliance, according to a report released this week.

The nonprofit Patient Rights Advocate (PRA) released its fifth semi-annual report, which found that only 36% of 2,000 surveyed hospitals were in complete compliance with the rule.

Since Jan. 1, 2021, hospitals have been required to give “clear, accessible pricing information” on their products and services, either through an online file or a “consumer-friendly” display of shoppable services.

The PRA’s report specifically found that while most hospitals have posted files about their prices, 64% of them had files that were incomplete or listed prices that were not “clearly associated with both payer and plan.” Another 69 hospitals — 3.5% — did not post usable files on their charges.

While less than half of all hospitals were found to be in complete compliance, that is still higher than the 25% compliance rate that was reported in February.

The data used for this report was gathered from publicly available hospital websites from May 9 through July 14.

“Continued noncompliance impedes the ability of employer and union purchasers, patients, and technology developers to analyze and compare prices,” the PRA said in its report.

The PRA also examined the enforcement of penalties. The Centers for Medicare and Medicaid Services (CMS) is in charge of enforcing compliance, and as the PRA noted, two hospitals that were previously penalized monetarily came into compliance soon after.

“In February of 2023, CMS acknowledged in a blog post that 30% of hospitals (approximately 1,800) were still noncompliant,” the nonprofit said.

“Yet, in April of 2023, only two more hospitals were fined. Both were still found to be noncompliant in this review. As of the time of this report, a total of four hospitals have been penalized, 0.2% of the hospitals that CMS recognized as noncompliant. Clearly, CMS is not strongly enforcing the rule.”

The organization sent letters to congressional leaders and President Biden detailing its findings, asking that further action be taken in order boost hospital price transparency and compliance with the existing rule.

The PRA recommended “increased, meaningful fines for noncompliance,” cutting down loopholes that allow hospitals to skirt the rule and expanding price disclosure requirements to include providers at all points of care.