Health insurance application Theprovision is part of the broader rules released for state exchangesthat also requires exchanges to conduct regular eligibilityverifications using outside data sources such as Medicare andMedicaid. (Photo: iStock)

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In a measure that, according to Becker's Hospital Review, is intended "tostrengthen the integrity of state-based insurance exchanges underthe ACA," insurers will be required to provide separate billing forabortion services.

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The rule, which, according to Modern Healthcare, was first proposed inNovember of 2018, will compel insurers each month to separate outand bill alone—premiums of at least $1 that are attributed to theabortion services that are not permitted to be paid for from publicfunding. So plan members, starting June 27 of 2020, will receiveand be required to pay two separate bills, in separatetransactions, with the other invoice covering all other health careservices premiums.

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The provision is part of the broader rules released for stateexchanges that also requires exchanges to conduct regulareligibility verifications using outside data sources such asMedicare and Medicaid. This will have to be done at least twiceeach year, beginning with plan year 2021.

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The Centers for Medicare and Medicaid claims that theeligibility verification requirement will help to make sure thatexchanges correctly determine consumer eligibility for advancepayments of the premium tax credit and cost-sharing reductionamounts. Exchanges also will have to conduct and submit findingsfrom annual programmatic audits to the federal government, thereport said, although CMS hasn't yet finalized changes to specifyhow extensive those annual audits will have to be.

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But insurers aren't happy about the rule, nor are experts whosay that the new rule will unduly burden both insurers andcustomers who may not understand that they'll have to pay aseparate invoice or risk losing their coverage.

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"Healthcare is complex enough as itis" said Margaret Murray, CEO of the Associationfor Community Affiliated Plans, which represents safety-net plans,"Requiring people to pay two bills for one product—healthcoverage—is a non-solution in search of a problem. This misguidedrule will only succeed in introducing confusion to the marketplaceon a massive scale, and put millions of consumers at risk of losingtheir coverage." It could also, she added, push insurers intoeliminating coverage for abortion services.

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According to CMS estimates, insurers would have topay $2.7 million in 2020 to comply with the rule, as wellas some $385 million for nearly 3 million hours ofwork.

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In addition, the three state-based exchanges that do their ownbilling/payment processing will be on the hook for "millions incosts per year," according to Modern Healthcare, which cited a CMSestimate of approximately 3 million individuals as having beenenrolled in exchange plans that covered non-Hyde abortion servicesin 2019.

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Regarding the eligibility verification requirement, CMS said ina fact sheet, "Early identification of eligibility and enrollmentissues is particularly important for consumers who are eligible foror enrolled in other coverage because it can minimize the timethese consumers inadvertently receive tax credits that they willhave to pay back later and mitigate risks that they are not payingpremiums for a plan they no longer need."

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Marlene Satter

Marlene Y. Satter has worked in and written about the financial industry for decades.