CMS recently asked for the information of the practice of the payment of insurance premium for the beneficiary by third party. CMS is also requesting data on whether the enrollment of patients in the ACA by the providers (medical group, hospitals and physicians) be allowed when patients are eligible for Medicaid or Medicare.
Even though the Affordable Care Act granted health insurance to millions of people who couldn’t afford it otherwise, many are still finding it difficult to pay their coverage in spite of the financial assistance. Some people who couldn’t afford the coverage have not even bought any health insurance.
When patients, who cannot pay for coverage of insurance, visit a hospital for treatment, then hospitals pay their cheap premium to get reimbursement from the insurance company. And this reimbursed amount will be higher than the cost of the premium in many procedures.
CMS is concerned about the steering of patients eligible for Medicaid or Medicare into private ACA health plan. The main reason for this may be due to the higher reimbursement amount from private players as compared to the Medicaid and Medicare.
Andy Slavitt, CMS Acting Administrator said, “Ensuring access to high quality patient care is a top priority for us. We are concerned about reports that some organizations may be engaging in enrollment activities that put their profit margins ahead of their patients’ needs. These actions can limit benefits for those who need them, potentially result in greater costs to patients, and ultimately increase the cost of Marketplace coverage for everyone.”
In addition, CMS Deputy Administrator and Director of the Center for Program Integrity said, “Our goal is to protect patients from being unduly influenced in their decisions about their health insurance options, and to protect the integrity of all the programs we oversee.”
Some have raised questions like why the payment of the health insurance premium of the patients by employers and government is encouraged and called appropriate, while the payment by hospitals is deemed inappropriate. Commenting on that, CMS said that they oppose this practice and that is why the agency is asking for comments and information from the public about this practice, as well as suggestions and recommendations to prohibit and limit it.
CMS believes that such practice increases the overall cost of the healthcare system. Reports say that the agency is also planning to impose civil monetary penalties on third parties that steer patients eligible for Medicaid and Medicare to private health plans.