CMS has released an interim final rule, Patient Protection and Affordable Care Act; Third Party Payment of Qualified Health Plan Premiums (CMS—9943–IFC). This proposed rule defines criteria for health insurance providers in the federal marketplace to accept third party premium assistance from specific entities:
• Ryan White HIV/AIDS program;
• Specific Federal and State government programs
• Indian tribes, tribal organizations and urban Indian organizations.
The interim rule also states, “Our new standard does not prevent QHPs and SADPs from having contractual prohibitions on accepting payments of premium and cost sharing from third party payers other those specified in this interim final regulations.” This statement is being interpreted by BlueCross BlueShield of Louisiana as allowing them to implement policies that prohibit acceptance of third party premium payments from any third parties.
The interim rule directly conflicts with an earlier CMS document dated February 7, 2014, “The concerns addressed in the November 4, 2013 would not apply to payments from private, not-for-profit foundations.” If left to stand the providers will in effect negate the pre-existing exclusion that the Affordable Care Act brought. Patients with rare, expensive disorders will be disproportionately affected by this change.
How You Can Help:
Let your voice be heard! Send a letter to CMS letting them know that their rule negatively affects those with hemophilia by not allowing them to receive third-party co-payment and premium assistance from nonprofits. Without this assistance, we know of at least 750 families across the nation that will lose access to their treatment and factor!
*If you have any additional questions, please contact Katie Verb, Manager, Policy & Advocacy, Hemophilia Federation of America at (202) 675-6984 or firstname.lastname@example.org