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HHS Clarifies that QHPs Are Not Federal Health Care Programs

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius stated in an Oct. 30 letter that HHS does not consider qualified health plans (QHPs) purchased through the federal and state marketplaces (exchanges) to be federal health care programs. The guidance also states that certain other programs are not considered federal health care programs. As a result, the federal anti-kickback statute, which only applies to federal health care programs, will not apply to QHPs. The anti-kickback statute is a broad statute intended to reduce health care fraud by preventing the exchange of anything of value between health care providers and patients that would encourage the use of federal health care programs. With this decision, the federal anti-kickback statute will not be a barrier for hospitals that want to subsidize premiums for their patients. America’s Essential Hospitals is working with HHS and other relevant agencies to clarify additional issues related to hospitals’ ability to subsidize premiums.

Contact Xiaoyi Huang, assistant vice president for policy, at xhuang@essentialhospitals.org or 202-585-0127 for more information.

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