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'Qualified health plans' sold on exchanges not 'federal health care programs'

October 30, 2013

The Department of Health and Human Services today issued guidance concluding that it does not consider qualified health plans and other programs related to federal health exchanges, state health exchanges and certain other programs to be federal health care programs. “This conclusion was based upon a careful review of the definition of ‘federal health care program’ and an assessment of the various aspects of each program under Title I of the Affordable Care Act and consultation with the Department of Justice,” the agency said in a letter to Rep. Jim McDermott (D-WA). Because the federal anti-kickback statute only applies to federal health care programs, it will not apply to qualified health plans and, as a result, will not be a barrier for hospitals or health systems that wish to subsidize premiums for health plans purchased on the exchanges for individuals in need of assistance. AHA members can find more about the issue in a recent AHA Legal Advisory.