Provider groups are protesting a CMS rule interpreting the healthcare reform law that gives consumers a grace period for unpaid health insurance premiums will put them at significant risk of delivering services for which they won't get paid.
The Patient Protection and Affordable Care Act and the CMS rule give consumers a 90-day grace period if they don't pay their premiums before their insurer can drop their coverage. The rule applies to people in all states who obtain subsidized coverage through the new insurance exchanges. That likely will constitute 80% of insurance subscribers on the exchanges, said Jennifer Kowalski, vice president of the health reform practice at consulting firm Avalere Health.
Under the rule interpreting the law, insurers offering plans on the exchanges must provide a three-month grace period to individuals who have enrolled and who have stopped paying their premiums. In the first 30 days, the insurer must continue to pay incurred claims. But for subscribers who ultimately fail to pay premiums within the 90 days and whose coverage is terminated, payers are not required to pay for claims incurred during the last 60 days of the 90-day period.
That has provider groups such as the American Hospital Association, the Federation of American Hospitals, the MGMA-ACMPE, the Missouri Hospital Association and the Missouri State Medical Association steaming.
“This process unduly burdens physicians, hospitals and other healthcare providers who must then collect payment from the patient, and puts them at an unfair and significant risk for providing uncompensated care to patients,” MHA CEO Herb Kuhn and Missouri State Medical Association Executive Vice President Thomas Holloway wrote in an Aug. 12 letter to CMS Administrator Marilyn Tavenner.
“Physicians, hospitals and other healthcare providers cannot reasonably be expected to know or predict if an enrollee's premiums are paid or will be paid before the end of the grace period,” the letter continued. “If the current rules cannot be amended or interpreted in a more equitable manner, we fear there will be a widespread reluctance among physicians and other providers to participate in exchange plans.”