CMS (Twice) Clarifies Third Party Payments of Premiums

CMS (Twice) Clarifies Third Party Payments of Premiums

Saturday, March 15, 2014
U.S. Department of Health and Human Services

Marketplace health plans must accept premium and cost sharing payments made by Ryan White grantees on behalf of their clients, according to a March 2014 interim final rule issued by HHS's Centers for Medicare and Medicaid Services (CMS). The rule "requires issuers of qualified health plans (QHPs), including stand-alone dental plans (SADPs), to accept premium and cost-sharing payments made on behalf of enrollees by the Ryan White HIV/AIDS Program, other Federal and State government programs that provide premium and cost sharing support for specific individuals, and Indian tribes, tribal organizations, and urban Indian organizations."

The March 2014 rule expands upon an earlier February 7, 2014 CMS FAQ, which stated the allowability of such third party payments on behalf of Ryan White clients. In turn, the February FAQ was issued to clarify an even earlier November 4, 2013 FAQ on third party payments. 

Restrictions of third party payments by hospitals, providers, and other commericial entities exist "due to concerns that such practices could skew the insurance risk pool and create an unlevel field in the Exchanges," according to CMS's March 12, 2014 rule.

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