Dive Brief:
- The American Hospital Association has sent out a legal advisory telling hospitals that federal regulations "clearly allow for another person or organization to pay the insurance premium for the enrolling individual."
- The legal analysis also states that there is no prohibition against hospital-affiliated charitable foundations, or u nrelated charities, paying these premiums.
- CMS previously sent out its own guidance in a letter which strongly discouraged hospitals from paying such premiums, arguing that hospitals would end up paying for their most expensive patients, thus skewing the risk pool.
Dive Insight:
It seems all but certain that hospitals will accept the AHA's advice and find a way to pay for premiums for at least some of their most expensive patients who can't afford HIX premiums. This is one situation where the understandable fear of CMS will be outweighed by the desire to reduce bad debt. The hospitals had better hurry, though; if they can't get this done by the end of open enrollment next year, they're out of the game for a while.