CMS May Cut Hospital Insurance Fee
Nov. 27—Hospital risk pool contributions would drop from previously planned amounts, under a proposed rule issued this week.
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule Nov. 25 outlining payment parameters for the 2015 benefit year, which included standards for the so-called premium stabilization programs for health plans tailored to the requirements of the Affordable Care Act.
The rule included provisions that would reduce the expected $63 per capita contribution of hospitals to a reinsurance poll for health insurance plans in the new government-run marketplaces, or exchanges. The rule proposed a hospital contribution rate of $44 per capita to the pool designed as a backstop of marketplace plans with disproportionately high numbers of high-cost enrollees.
The contributions are required from both insured and self-funded health plans (including those that use third party administrators), according to the rule.
The CMS rule would exempt some self-funded health insurance plans (generally union-operated plans) from any reinsurance pool contributions or 2015 and 2016.
Additionally, hospitals that contract with health insurance plans sold through the marketplaces, or exchanges, would not need—for now—an agreement with a Patient Safety Organization.
The ACA required that before hospitals with more than 50 beds could contract with a marketplace plan they had to meet certain patient safety standards, including use of a patient safety evaluation system. However, the ACA also gave the U.S. Health and Human Services secretary “flexibility to establish reasonable exceptions to these patient safety requirements,” the rule said.
The delay in the safety requirements came because a Jan. 1, 2015 implementation “could result in a shortage of qualified hospitals and providers available for contracting with QHPs [marketplace plans],” the rule said.
Comments on the proposed rule are due Dec. 26.
Publication Date: Wednesday, November 27, 2013