CMS Mulling Changes to Federal Rules on Third-Party Payments
CMS over the weekend said it is considering an amendment to existing federal rules so that insurers would be required to accept third-party payments from federal programs designed to help people with HIV/AIDS, Reuters reports.
Some of those programs were established under the 1990 Ryan White Act. The Ryan White HIV/AIDS Program helps low-income individuals pay for primary care, support services and medications.
CMS began considering the change after Blue Cross and Blue Shield of Louisiana began rejecting checks from the Ryan White program for hundreds of residents with HIV/AIDS and notifying them that their new coverage though the federal health insurance exchange under the Affordable Care Act would be discontinued (Berkrot/Begley, Reuters, 2/9).
According to Reuters, the insurer claimed that its decision was driven by a 2013 CMS directive about third-party payments and the interpretation of the agency's rules to eliminate fraud under the ACA.
The November 2013 directive warned "hospitals, other health care providers and other commercial entities" not to accept third-party payments because of fraud risks, just months after the agency told insurers that they could accept Ryan White funds "to cover the costs of private health insurance premiums, deductibles and co-payments" (Begley/Steenhuysen, Reuters, 2/8).
BCBS of Louisiana said it moved to stop accepting the Ryan White program payments in an effort to avert the possibility of fraud and noted that it was not attempting to block state residents with HIV/AIDS from enrolling in its federal exchange plans (Reuters, 2/9).
However, Jessica Stone -- a health policy expert in Sen. Mary Landrieu's (D-La.) office -- wrote in a staff memo earlier this month, "BCBS LA told me their decision was not due to the CMS guidance or any confusion ... but was in fact due to adverse selection concerns."
The insurer rejected that comment, noting that it was not engaging in adverse selection efforts. A BCBS of Louisiana spokesperson added, "We welcome all Louisiana residents who choose [its plans]."
CMS spokesperson Tasha Bradley on Friday said that insurers are permitted to use Ryan White "funds to pay for premiums on behalf of eligible enrollees in [exchange] plans, when it is cost-effective for the Ryan White program." She added, "The third-party guidance CMS released (in November 2013) does not apply to" the Ryan White program (Reuters, 2/8).
In addition, CMS in a statement on Saturday said that although it already had issued guidance instructing insurers "to accept such payments ... Given the importance of access to care for people with HIV/AIDS, CMS is considering amending those rules to require issuers to accept" payments from the program (Reuters, 2/9).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.