The provision is part of the broader rules released for state exchanges that also requires exchanges to conduct regular eligibility verifications using outside data sources such as Medicare and Medicaid. (Photo: iStock)
In a measure that, according to Becker's Hospital Review, is intended "to strengthen the integrity of state-based insurance exchanges under the ACA," insurers will be required to provide separate billing for abortion services.
The rule, which, according to Modern Healthcare, was first proposed in November of 2018, will compel insurers each month to separate out and bill alone—premiums of at least $1 that are attributed to the abortion services that are not permitted to be paid for from public funding. So plan members, starting June 27 of 2020, will receive and be required to pay two separate bills, in separate transactions, with the other invoice covering all other health care services premiums.
The provision is part of the broader rules released for state exchanges that also requires exchanges to conduct regular eligibility verifications using outside data sources such as Medicare and Medicaid. This will have to be done at least twice each year, beginning with plan year 2021.
The Centers for Medicare and Medicaid claims that the eligibility verification requirement will help to make sure that exchanges correctly determine consumer eligibility for advance payments of the premium tax credit and cost-sharing reduction amounts. Exchanges also will have to conduct and submit findings from annual programmatic audits to the federal government, the report said, although CMS hasn't yet finalized changes to specify how extensive those annual audits will have to be.
But insurers aren't happy about the rule, nor are experts who say that the new rule will unduly burden both insurers and customers who may not understand that they'll have to pay a separate invoice or risk losing their coverage.
"Healthcare is complex enough as it is" said Margaret Murray, CEO of the Association for Community Affiliated Plans, which represents safety-net plans, "Requiring people to pay two bills for one product—health coverage—is a non-solution in search of a problem. This misguided rule will only succeed in introducing confusion to the marketplace on a massive scale, and put millions of consumers at risk of losing their coverage." It could also, she added, push insurers into eliminating coverage for abortion services.
According to CMS estimates, insurers would have to pay $2.7 million in 2020 to comply with the rule, as well as some $385 million for nearly 3 million hours of work.
In addition, the three state-based exchanges that do their own billing/payment processing will be on the hook for "millions in costs per year," according to Modern Healthcare, which cited a CMS estimate of approximately 3 million individuals as having been enrolled in exchange plans that covered non-Hyde abortion services in 2019.
Regarding the eligibility verification requirement, CMS said in a fact sheet, "Early identification of eligibility and enrollment issues is particularly important for consumers who are eligible for or enrolled in other coverage because it can minimize the time these consumers inadvertently receive tax credits that they will have to pay back later and mitigate risks that they are not paying premiums for a plan they no longer need."
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Marlene Satter
Marlene Y. Satter has worked in and written about the financial industry for decades.
