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Insurers Must Accept AIDS Program Payments

WASHINGTON (CN) - A change to the Affordable Care Act requires health plans to accept payments from the Ryan White HIV/AIDS Program and government programs that provide tribal cost support. The Department of Health and Human Services' regulation affects qualified health plans and stand-alone dental plans, according to the action.

The government established the Ryan White HIV/AIDS Program in 1990 to help low-income HIV/AIDS patients pay for health insurance premiums. Named after a boy who contracted HIV from a blood transfusion, the program provides financial resources for people living with the disease and serves more than half a million people in the United States each year.

"We have become aware that, despite related policy clarifications, some qualified health plan issuers continue to reject payments of premium and cost sharing by the Ryan White HIV/AIDS Program," the agency said in the action.

The HHS' Centers for Medicare and Medicaid Services noted that it was not aware of the need for the new rule until the first enrollment period for Obamacare began last October."We assumed that issuers of qualified health plans and stand-alone dental plans would continue to accept these payments as these issuers had done prior to the availability of coverage through the exchanges, and thus the impact of such third party payments was built into their baselines," according to the agency. But because some issuers refused to accept payments from programs like the Ryan White program despite repeated clarifications, the agency found that there was good cause to enforce the rule immediately "given that a delay in coverage for people who rely on one of the third parties noted in the regulation to pay their premiums could result in worsening medical conditions," the agency said. Failure to accept those third party payments could result in a penalty of $100 per day for each person adversely affected by the failure to comply.

"We consider this policy to be a benefit to consumers. Recent studies have demonstrated that individuals with HIV on antiretroviral medications who achieve viral load suppression are less likely to transmit HIV to others," the agency said. "Ensuring access to care and treatment services supports the achievement of viral suppression, and, therefore, has a significant public health impact on HIV incidence as well.

"The agency noted that its new standard does not prevent health plans from prohibiting certain other third party payments.

"We remain concerned that third party payments of premium and cost sharing provided by hospitals, other healthcare providers, and other commercial entities could skew the insurance risk pool and create an unlevel competitive field in the insurance market," the agency noted. "We continue to discourage such third party payments of premiums and cost sharing, and we encourage qualified health plans and stand-alone dental plans to reject these payments.

"The agency waived the usual 30-day delay in the effective date both to ensure that at-risk individuals have access to continuing care, and to enable the agency to take immediate enforcement action against issuers that continue to refuse to accept the specified third party payments.

The interim final rule became effective March 14, 2014. Comments are due by May 13.

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