America’s Essential Hospitals submitted comments June 11 to the U.S. Departments of Labor, Health and Human Services, and the Treasury (the departments) regarding their request for information on the Affordable Care Act’s (ACA’s) provider nondiscrimination provision. The ACA’s nondiscrimination provision prohibits health insurance plans from discriminating against providers acting in accordance with their state license or certification with respect to participation under the plan.
America’s Essential Hospitals provided findings that show some insurance plans exclude essential hospitals that are essential community providers (ECPs), reimburse them at lower than market cost, and include them in less favorable tiers. This creates barriers to health care for newly insured low-income people, as they could be forced to find new providers who are in their network but have less experience serving vulnerable patients or pay higher out-of-pocket costs to stay with their current, essential hospital provider. The association made the following recommendations to the departments:
- Require that insurers use a good faith and reasonable interpretation of the ACA to ensure essential hospitals are included in these networks.
- Clarify that the ACA’s nondiscrimination provision limits health plans’ ability to vary provider rates based on arbitrary factors and to reimburse at levels below the cost of care.
Additionally, the association signed onto a comment letter with a coalition of eight other health care associations representing providers, clinics, and hospitals. The letter addresses concerns about provider and hospital exclusion, below-market reimbursement, and tiered plans. Please contact Xiaoyi Huang, JD, director of policy, at firstname.lastname@example.org or 202.585.0127 with questions.