The federal government would provide 95% of the project cost of subsidizing the plans in states choose to offer one. Participating states must align their basic health plans with coverage offered through their insurance exchange and Medicaid and CHIP programs.
The comment letters the CMS received on the proposed rule were largely positive.
Some stakeholders fear, however, that the regulatory framework creates barriers to coordinated care because it seems to discourage the use of managed-care organizations to administer the plans.
Connecticut state lawmakers, for example, are pushing for wording that would allow the state to award a managed-care contract for its basic health plan—and without that, they say they're unable to determine whether to participate.
Officials with New York's state-operated exchange, meanwhile, said the CMS proposal is too prescriptive in laying out the details that states must negotiate with insurance companies that would offer basic health plans.
The policy unnecessarily requires that the negotiations cover case management and incentives for preventive services in addition to premiums, cost sharing and benefits, according to a letter from New York State of Health. “New York believes that the States are in the best position to determine how to operate the competitive contracting processes within the bounds of federal law,” officials said in the letter.
Another concern is the “blueprint” documents in which states must explain how they will implement the program. These documents must be submitted to the government for approval for certification and approval, similar to the process states took to establish their own exchanges.
The proposed rule indicates that states must describe the “amount of the premium imposed on enrollees” in the blueprint, and insurers say states are unlikely to have enough information.
Indianapolis-based WellPoint, one of the largest health insurers in the U.S., said “states will likely not know which carriers will be providing BHP coverage or what the rates will be at the time of Blueprint submission.”
WellPoint suggests that the CMS instead ask states to describe how the premium will be set, not what premium will be charged per beneficiary.
The American Hospital Association, meanwhile, argues in its letter that basic health plans should be required to pay providers for medical care delivered during a three-month grace period before coverage is terminated when enrollees stop paying premiums. The proposed regulation allows the plans to stop paying claims for services rendered in the second and third months.
“It unfairly burdens providers who treat these patients because they will not get paid by the (insurer) for covered services and will have to wait to try to obtain direct payment from the patient,” AHA said in its letter to the CMS. “The reality is that it will be extremely difficult to collect payment from low-income patients who already are having trouble paying their (health plan) premiums.”
Provider groups have raised similar objections to the CMS position on the grace period for plans sold in the exchanges.
Follow Virgil Dickson on Twitter: @MHvdickson
