HHS Publishes Rule Requiring Health Plans to Accept 3rd Party Payments from Ryan White

On March 19, 2014, HHS published an interim final rule in the Federal Register that requires issuers of qualified health plans (QHPs), including stand-alone dental plans (SADPs), offered through the ACA’s Health Insurance Marketplaces to accept premium and cost-sharing payments made on behalf of enrollees by the Ryan White HIV/AIDS Program, other Federal and State government programs that provide premium and cost sharing support for specific individuals, and Indian tribes, tribal organizations, and urban Indian organizations.

The rule states:

We have become aware that, despite related policy clarifications, some qualified health plans (QHP) issuers continue to reject payments of premium and cost sharing by the Ryan White HIV/AIDS Program. In particular, this QHP issuer practice is causing access problems for persons who rely on the Ryan White HIV/AIDS Program for assistance. Accordingly, we are promulgating a new requirement at § 156.1250 that QHP and SADPs must accept third party premium and cost sharing payments from the Ryan White HIV/AIDS Program.

To ensure that individuals reliant on programs similar to the Ryan White HIV/AIDS Program are not being adversely affected by QHPs' and SADPs' refusal to accept third party premium and cost-sharing payments, we are including within the new requirement that QHPs and SADPs must accept third party premium and cost-sharing payments from the following other entities in addition to the Ryan White HIV/AIDS Program: Indian tribes, tribal organizations, and urban Indian organizations; and state and federal government programs. This standard applies to all individual market QHPs and SADPs, regardless of whether they are offered through an FFE, an SBE, or outside of the Exchanges.

Read the full rule, Patient Protection and Affordable Care Act; Third Party Payment of Qualified Health Plan Premiums.

This rule formalizes earlier clarifications made by the Centers for Medicare and Medicaid Services that third party premium and cost-sharing payments made by state and federal programs and grantees, including the Ryan White HIV/AIDS Program, on behalf of QHP enrollees are allowable and encouraged.