Home Health Care CMS final rule requires state exchanges to bill separately for abortion coverage

CMS final rule requires state exchanges to bill separately for abortion coverage

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The Centers for Medicare and Medicaid Services issued a final rule on Friday that would require Affordable Care Act exchanges to charge members a separate bill from their premium for abortion coverage. The change is part of CMS’ Exchange Program Integrity Final Rule, which also steps up oversight of state-based exchanges.

Not all exchange plans offer abortion coverage, but those that do previously allowed insurers to send a single bill that itemized premium costs and abortion coverage. Now, CMS is requiring those plans to send two entirely separate bills.

“The separate billing requirement fulfills Congress’ intent and reflects President Trump’s strong commitment to preventing taxpayer funding of abortion coverage,” Department of Health and Human Services Secretary Alex Azar said in a statement.

Per the final rule, insurers providing abortion coverage will be required to send patients a separate bill of at least $1 to cover abortion benefits starting on June 27, 2020.

Industry groups raised concerns after the rule was first proposed in November of last year, out of fear that plan members who miss the second bill might risk losing their insurance altogether.

Six organizations, including the American Academy of Family Physicians and the American Medical Association, signed a January 8 letter to Azar saying the rule as proposed would place “immense administrative burdens on and create considerable confusion for patients that may jeopardize their health insurance coverage.”

“While we appreciate that issuers will not be permitted to refuse to accept a combined payment or to terminate coverage based on receipt of a combined payment, we are fearful that consumers will fall through the cracks by underestimating the consequences of not paying their premiums in full. Indeed, if a consumer fails to pay their monthly premium payment in full – either intentionally or unintentionally –the consumer will have 90 days from the date of the missed payment to reconcile their balance or risk termination of benefits,” the letter stated.

The changes would also bring a burden for payers.

Blue Shield of California previously wrote in a letter that the changes would cost insurers far more to implement than they would collect. The insurer estimated the new requirement would increase operational costs by $900,000 per month, with a large portion of the increase attributed to the cost of printing and mailing twice as many bills.

Since January, CMS has tweaked the final rule slightly to reduce those costs. Now, insurers can send the two paper bills in one envelope, but consumers are still required to write two checks or make two separate card payments.

CMS estimated the changes would affect 1,467 health plans, with an average annual cost of $1.07 million per issuer. The agency also estimated a one-time implementation cost of roughly $2.7 million for each issuer.

Some state agencies, including the California Department of Insurance, pushed back.

“The Department of Insurance will fight to prevent this rule from ever going into effect,” California Insurance Commissioner Ricardo Lara said in a statement on Friday.

 

Photo credit: lbodvar, Getty Images

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