Affordable Care Act exchange insurers must send separate bills to consumers for the portion of their premiums attributable to certain types of abortion services, according to a final rule.
The rule released Friday by the Centers for Medicare & Medicaid Services imposes the new requirements on insurers to ensure they meet a federal prohibition on public funding for abortion coverage, officials said. It also has new requirements for states to help identify people who are enrolled on both exchanges in addition to other government health programs.
“Today’s final rule drastically improves our ability to pay it right—to make the right payment to the right plan for the right people,” said CMS Administrator Seema Verma in a statement Friday.
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The Hyde Amendment, which is a rider added to every congressional spending bill, prohibits federal funds from covering abortions. The ACA requires insurers to collect a separate payment from each plan enrollee for the portion of their premium attributable to abortion coverage and services.
The rule aims to clarify this requirement for insurers. CMS estimates 18 states have qualified health plan issuers that offer coverage of abortion services that under the Hyde Amendment cannot be reimbursed by federal funds.
Under the rule, a qualified health plan issuer must send an entirely separate monthly bill to the customer for only the portion of their premium tied to abortion coverage.
The insurer must also tell the consumer that they must pay for any abortion coverage or services.
“The rule better aligns with Congress’ intent for [qualified health plan] issuers to collect two distinct payments, one for the coverage of non-Hyde abortion services, and one for coverage of all other services covered under a [qualified health plan],” CMS said in a release on the rule.
The new requirements begin on an insurer’s first billing cycle that starts on or after “the date that is six months after publication of the final rule,” an explainer on the rule said.
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The rule also clarifies the scope of annual audits that must be submitted to CMS. The changes include new procedures to ensure that state-based exchanges operate their own eligibility and enrollment platforms to determine if consumers are eligible for tax credits.
Starting next year, CMS will also require state-based exchanges to conduct data matching at least twice a year for customers that get tax credits.
The goal is to catch whether beneficiaries on the exchanges are eligible for Medicare, Medicaid, Children’s Health Insurance Program and, when applicable, basic health plans.
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CMS put together the rule in response to an investigation by the federal watchdog Government Accountability Office.
A 2018 investigation found that about 1% of enrollment in ACA signups in 2015 were “potentially improper or fraudulent.”
In 2016, GAO made 15 false applications to obtain tax credits. GAO was able to obtain tax credits for eight applications even though their identities were false.