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Groups urge CMS to comply with ACA coverage provision

August 15, 2013

The AHA, Federation of American Hospitals, and Association of American Medical Colleges today urged the Centers for Medicare & Medicaid Services to require qualified health plans to provide health coverage for a full three-month grace period for nonpayment of premiums by people who qualify for advance payment of premium tax credits, as mandated by the Patient Protection and Affordable Care Act. A recent CMS final rule required QHPs only to pay all appropriate claims for services provided during the first month of the grace period. “The effect of this policy is to allow QHPs to retroactively terminate coverage for the second two months of the grace period,” the organizations wrote. “This shifts the burden related to patient protections during most of the grace period from QHPs to health care providers…Without payment for covered services, there is only an illusion of continued coverage during the 90-day grace period, not the actual continued coverage required by law.” CMS “promulgated this final policy without any indication of such a possibility in the proposed rule,” the letter notes. “Thus, affected stakeholders had no meaningful opportunity to comment.”