On March 19, 2014, HHS published an interim final rule on third party payments of Qualified Health Plan Premiums.  The rule specifically requires insurance plan issuers to accept third party payments from Ryan White HIV / AIDS Program.  The rule, however, continues to discourage health plan issuers from accepting payments from “hospitals, other healthcare providers, and other commercial entities”.  The HHS position on these type third party payments is that they “could skew the insurance risk pool and create an unlevel competitive field in the insurance market”.

CMS began addressing this area of ACA in November 2013 when it published “Frequently Asked Questions” or “FAQs” with respect to premium and cost-sharing payments made by third parties on behalf of Qualified Health Plan (QHP) enrollees (read the FAQ here).  On February 7, 2014, CMS issued additional FAQs (the February FAQs) clarifying that the November FAQ.  This final rule solidifies the position of CMS and puts enforcement in the hands of HHS for insurance companies who refuse to accept the allowed third-party premium payments.

Although the final rule does not prohibit insurers from accepting third party payments from hospitals or other healthcare providers, it encourages health insurers to reject such payments.  Considering that accepting such payments would not be in the interest of insurance companies, it is reasonable to assume that the “encouragement” from DHHS will effectively prohibit such transparent payment of premiums.

For more details, read the interim final rule here.