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CMS Seeks Information on Medicare, Medicaid Patient Diversion

The Centers for Medicare & Medicaid Services (CMS) has issued a request for information (RFI) seeking public comment on concerns that some health care providers might be steering patients who are eligible for Medicare or Medicaid into individual market plans to obtain higher payment rates.

CMS is particularly interested in the frequency and impact of this practice, as well as options to limit its use. The agency believes that diverting Medicare- and Medicaid-eligible patients into private plans could:

  • raise overall health system costs;
  • disrupt the continuity and coordination of patient care because of shifting provider networks; and
  • have a negative impact on marketplace risk pools.

CMS also reiterated its opposition to third-party payment of premiums and cost-sharing associated with private coverage. CMS strongly encouraged providers to stop paying for premiums and cost-sharing associated with private plans for Medicare- and Medicaid-eligible patients. CMS is considering options to prohibit or limit such payments, in addition to assessing civil monetary penalties for providers that cause late enrollment penalties for Medicare-eligible individuals.

If you have questions or concerns, contact Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127.

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About the Author

Matt Buechner is the policy and advocacy associate for America's Essential Hospitals.