CMS sets sights on nondiscrimination compliance

Insurers selling exchange plans that try to boost young adult enrollment by discriminating against consumers with significant health needs or disabilities should be wary of compliance reviews, according to new qualified health plan (QHP) guidance from the Centers for Medicare and Medicaid Services.

Compliance reviews at insurer and health plan levels will scrutinize health and disability discrimination relative to federal exchange participation standards, plan design and plan notice, LifeHealthPro reported.

In the guidance, CMS prohibits discrimination based on race, color, national origin, disability, age, sex, gender identity or sexual orientation. The agency also bans marketing practices or benefit designs that will deter the sickest individuals from purchasing federal marketplace plans.

Such guidance could ease concerns that healthcare reform coverage may be inadequate for the chronically ill. Chronically ill adults enrolled in skinny (or bronze-level) health exchange plans are apt to reach out-of-pocket maximums annually, rendering them underinsured, FieceHealthPayer previously reported.

In addition to health-related nondiscrimination, CMS requires insurers to make sure health plan applications, notices and enrollment information packages meet readability and accessibility standards for individuals with disabilities or limited English proficiency.

However, federal health officials pointed out that the guidance does not represent an all-inclusive list, adding that CMS can review compliance with standards not listed.

CMS has touted other nondiscrimination policies of late, such as strengthening health insurance protections for same-sex couples and HIV/AIDS patients. Last month, CMS said insurers offering spousal coverage to heterosexual couples also must provide that benefit to same-sex couples who were legally married in a state that recognizes same-sex marriage--regardless of the jurisdiction in which the policy is offered, renewed or where the policyholders live.

To learn more:
- check out the CMS guidance (.pdf)
- read the LifeHealthPro article