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CMS Releases Rule on QHP Payments by Third Parties

On March 14, the Centers for Medicare & Medicaid Services (CMS) released an interim final rule that requires qualified health plan (QHP) issuers to accept premium and cost-sharing payments made on behalf of enrollees by the Ryan White HIV/AIDS Program; Indian tribes, tribal organizations, or urban Indian organizations; and state or federal government programs. CMS encourages QHPs to reject third-party premium and cost-sharing payments from hospitals and other health care providers.

The rule does not provide information about premium and cost-sharing payments made on behalf of QHP enrollees by private, nonprofit foundations. However, on Feb. 7, CMS released FAQs that stated private, nonprofit foundations may make premium and cost-sharing payments on behalf of QHP enrollees who meet criteria based on financial status and not health status.

America’s Essential Hospitals will submit comments to CMS urging the agency to more formally allow such payments from private, nonprofit foundations.

Please contact Xiaoyi Huang, director of policy, at xhuang@essentialhospitals.org or 202.585.0127 with questions.

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