COVID-19: In response to outbreak, CMS Outlines New QHP Flexibilities re: Premium Payment Deadlines

By: | March 24, 2020

In response to the COVID-19 national emergency, the Centers for Medicare & Medicaid Services (CMS) recently released a memorandum outlining new flexibilities available to qualified health plans (QHPs) participating in an Affordable Care Act (ACA) Exchange. Specifically, the memo details that, for the duration of the national emergency, CMS will permit QHPs on State and Federal Exchanges to:

  • Extend premium payment deadlines; and
  • Delay coverage cancellations or terminations due to an enrollee’s failure to pay a health care premium (with the permission of applicable state regulatory authorities).

CMS notes these flexibilities will also apply to individuals receiving advance payments of the premium tax credit (APTC).

The agency is offering such flexibilities by exercising enforcement discretion with regard to existing premium payment and coverage termination requirements. It also encourages State-based Exchanges to “take a similar approach.”

As CMS states, this policy allows issuers to extend payment deadlines and delay the beginning of an applicable grace period. However, once a grace period begins, CMS states that all basic grace period requirements will still apply, including a requirement that plans must pay all appropriate claims for services rendered to individuals receiving APTC during the first month of a three-month grace period. As plans may pend claims during the second and third months of the grace period, CMS states that plans must notify providers of the possibility that an enrollee’s claims may be denied after the first month of the grace period.

Issuers must also notify the U.S. Department of Health and Human Services (HHS) of any coverage terminations after a grace period ends (which, as CMS notes, will result in issuers returning the APTC for the second and third months of the exhausted grace period).

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Josh LaRosa