Patient advocacy groups are pushing bipartisan legislation that would require qualified health plans to accept premium payments from charitable organizations since CMS has so far refused to impose such a requirement. Patient organizations say CMS' silence on the issue leads plans to reject payments on behalf of chronically ill patients and threatens to undermine the goal of the Affordable Care Act.
CMS issued an interim final rule in March 2014 clarifying that QHPs must accept third-party payments from the Ryan White program and from tribal entities, but did not mandate that plans need to accept payments from charitable organizations. Advocates say this led to plans rejecting payments in at least 35 states.
In the proposed Notice of Benefit and Payment Parameters for 2017, CMS suggested it was considering broadening the entities from which issuers must take payments to include nonprofit charities. Consumer advocates, stakeholders, hospitals and the pharmaceutical industry offered strong support for the idea, while the insurance industry blasted the suggestion. Insurers believe the move could lead to adverse selection, higher costs and potentially encourage providers to over-treat patients.