On March 19, 2014, the Centers for Medicare & Medicaid Services (CMS) issued federal guidance on third-party insurance payments for the new Exchange plans offered under the Affordable Care Act (ACA). In direct contradiction to the standard currently used by Medicare for non-profit charity, third-party payers, CMS failed to include non-profits on the list of acceptable arrangements for patients covered by qualified health plans (QHPs).
As a result, health plans can now deny coverage to patients by rejecting the premium assistance they were receiving from non-profit third parties. Exemptions have been extended to the Ryan White HIV/AIDS Program, Indian Tribes, and other state and federal programs – but not non-profits.
This harmful guidance is enabling insurers to exclude patients with expensive – yet devastating – conditions from their plans, undermining the intent of the ACA and unraveling the safety net patient assistance groups have worked so hard to create. In fact, insurance companies in 37 states have already cited this rule to deny coverage to patients who receive non-profit assistance – and many others are likely to follow suit.
The proposed legislation:
The Access to Marketplace Insurance Act (H.R. 3742) is bipartisan legislation that would override the CMS guidance on third-party payments and require health insurance companies to accept payments from non-profit organizations that operate in compliance with the False Claims Act.
By creating a carve-out for non-profits to provide premium assistance under the CMS third-party guidance, H.R. 3742 would go a long way toward helping patients suffering from devastating diseases access the treatments and services they need to manage their conditions and lead productive lives.
The Life Raft Group’s position:
The Life Raft Group is committed to the premise that patients shall be held harmless from the infighting between government, pharmaceutical, payors or private agencies. We are against any legislation that makes it more difficult for a cancer patient to receive lifesaving treatment.
To this end, the LRG lends support to the Access to Marketplace Insurance Act, H.R. 3742, legislation that would override the CMS guidance on third-party payments and require health insurance companies to accept payments from non-profit organizations that operate in compliance with the False Claims Act.
The Life Raft Group has joined the Marketplace Access Project, a patient advocacy movement dedicated to protecting non-profit insurance premium assistance for individuals suffering from chronic and life-threatening illness.
For more information on H.R. 3742, and how you can support it, click here.