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In response to letters by Patient Services Incorporated (PSI) and other patient advocacy groups, CMS has released a further explanation on the November 4, 2013, Frequently Asked Question (FAQ) document. As you will remember, CMS called into question the use of premium assistance, the FAQ stated:

The Department of Health and Human Services (HHS) has broad authority to regulate the Federal and State Marketplaces (e.g. section 1321(a) of the Affordable Care Act). It has been suggested that hospitals, other healthcare providers and other commercial entities may be considering supporting premium payments and cost-sharing obligations with respect of qualified health plans purchased by patients in the Marketplaces. HHS has significant concerns with the practice because it could skew the insurance risk pool and create an unlevel field in the Marketplaces. HHS discourages this practice and encourages issuers to reject third party payments. HHS intends to monitor this practice and to take appropriate action if necessary.

Because of questions we received from our donors and a concern for those receiving health insurance premium assistance, PSI wrote to Secretary Sebelius expressing our concerns, specifically, the PSI letter states, “We are concerned that any ambiguity or threat of new regulation could create unnecessary confusion for patients trying to access care in the coming months and years as the Exchanges are implemented and patient seek to take advantages of its benefits”.

In response to patient concerns including those of PSI, the Centers for Medicare and Medicare Services (CMS) released another frequently asked question document (FAQ) dated February 7th, 2014, which clarified the earlier one with regards to premium assistance. Specifically the FAQ stated:

Q2: Does the November 4, 2013 FAQ apply to QHP premium and cost sharing payments on behalf of QHP enrollees from private, not-for-profit foundations?

The concerns addressed in the November 4, 2013 FAQ would not apply to payments from private, not-for-profit foundation if: …(b) if they are made on behalf of QHP enrollees who satisfy defined criteria that are based on financial status and do not consider enrollees’ health status. In situations (b), CMS would expect that premium and any cost sharing payments cover the entire policy year.

PSI will continue to provide health insurance premium assistance accordingly to our PSI program parameters. We applaud the Department of Health and Human Services and the Centers for Medicare and Medicaid Services for issuing the clarification.

 

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