An interim final rule addressing third-party premium payments to qualified health plans is under regulatory review at the Office of Management and Budget, according to an online posting on that agency’s website on March 4, 2014. Both providers and payors have anxiously watched for clarifications in this area following a series of conflicting statements from HHS on the matter. The rule, when issued, will likely clarify whether certain entities may subsidize the purchase of health insurance on behalf of other individuals.

In October of 2013, Kathleen Sebelius stated in a letter to Congressman Jim McDermott that qualified health plans and other ACA-funded government programs would not be considered “federal health care plans” for the purposes of the federal Anti-Kickback Statute. Many interpreted Sebelius’s statement that the AKS would not apply as allowing providers to make premium payments on behalf of uninsured patients, thus ensuring that providers would receive payment for what would otherwise likely be uncompensated care. But a few days later, the Centers for Consumer Information and Insurance Oversight issued a FAQ encouraging insurers to reject payments from third parties, citing concerns that such payments would distort the risk pool. It later clarified that payments from Indian tribes, state and federal assistance programs, and private, not-for-profit foundations were acceptable.

The OMB posting offers no substantive information about the content of the eventual rule and no timeline for its release. Because it is being issued as a final rule, it will be implemented upon release or shortly thereafter, with time for comments following its implementation.