CMS Focuses On Provider Steering Of Medicare- And Medicaid-Eligible People To Marketplaces

Aetna’s August 15 announcement that is reducing its marketplace participation from 778 to 242 counties has further focused attention on the need to stabilize marketplace risk pools. The Centers for Medicare and Medicaid Services (CMS) have already taken a number of steps toward this end this year, such as tightening up special enrollment periods, improving data matching procedures, and proposing regulatory changes to discourage the sale of short-term or fixed indemnity policies, which siphon off healthy individuals from ACA-compliant comprehensive coverage. On August 18, CMS took a further step, addressing a concern expressed by insurers that providers and provider-affiliated organizations are steering people eligible for Medicare and/or Medicaid coverage to individual marketplace plans to obtain higher provider payment rates. CMS issued a “request for information,” asking for comments on the extent and nature of this practice and on what can or should be done about it. CMS also sent letters to all Medicare-enrolled dialysis facilities expressing the concerns found in the information request. Background Individuals who are eligible for Medicare or Medicaid are not required to enroll in these programs (although individuals eligible for Medicare Part A institutional care benefits must enroll in Part A if they receive Social Security). Medicare- or Medicaid-eligible individuals are, however, generally ineligible for marketplace premium tax credits or cost-sharing reduction...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Following the ACA Insurance and Coverage Medicaid and CHIP Medicare APTC risk pools Source Type: blogs