The comment period closed today for an interim final rule that requires qualified health plans (QHPs) to accept premium and other cost sharing payments from certain federal and state programs and clarifies that failure to do so could result in a civil monetary penalty. The rule, promulgated on March 19th and effective on the same day, requires plans to accept payment from the Ryan White HIV/AIDS Program, other state and federal government programs, and Indian tribes, tribal organizations, and urban Indian organizations. The comments accompanying the rule note that “[o]ur new standard does not prevent QHPs and SADPs [dental plans] from having contractual prohibitions on accepting payments of premium and cost sharing from third party payers other than those specified in this interim final regulation.” The comments also reiterate previously expressed concerns that premium payments from hospitals, healthcare providers, and “other commercial entities” could distort the risk pool, but the rules do not explicitly prohibit QHPs from doing so. The rule is also silent on whether QHPs may reject premium payments from charitable organizations.

Not surprisingly, the most public comments on this issue have come from the American Hospital Association (AHA). In a letter to CMS Administrator Marilyn Tavenner, the AHA strongly urged that CMS reconsider its position discouraging premium assistance from providers, noting the work hospitals have done to assist individuals in enrolling in QHPs on the exchanges and the importance of broad coverage of currently-uninsured populations to the success of the Affordable Care Act. The AHA also notes that third-party payment of premiums may be particularly important in states that have elected not to expand Medicaid. On that point, the letter urges CMS to clarify that charitable organizations may make premium payments on behalf of others.

In issuing this very limited rule, CMS has taken the path of least resistance in dealing with the confusion surrounding whether and when third parties may make premium payments on behalf of others, protecting government and tribal programs but leaving plans free to make their own decisions regarding whether to accept payments from others. However, hospitals and other providers may push back against contractual prohibitions on third party payments or seek other avenues to achieve the same result.