HHS: Qualified health plans aren't federal healthcare programs

The U.S. Department of Health & Human Services clarified that qualified health plans sold on the health insurance exchanges are not federal healthcare programs.

In a letter to Rep. Jim McDermott (D-Wash.), HHS Secretary Kathleen Sebelius explained her agency doesn't consider qualified health plans, which were established under the healthcare reform law, as federal healthcare programs under the Social Security Act.

"The Department of Health and Human Services does not consider QHPs, other programs related to the Federally-facilitated Marketplace, and other programs under Title I of the Affordable Care Act to be federal healthcare programs," Sebelius wrote.

She added that the distinction extends to consumer-oriented and operated plans (CO-OPs) as well as federally-funded consumer assistance programs.

The clarification means the federal anti-kickback statute won't apply to qualified health plans and won't prevent hospitals or other health systems from subsidizing premiums for patients who buy insurance coverage on exchanges, AHA News Now reported.

It also suggests pharmaceutical manufacturers can provide co-pay coupons to consumers who buy health plans through the online marketplaces, according to a blog post from law firm Hogan Lovells.

To learn more:
- here's the HHS letter (.pdf)
- see the AHA News Now article
- read the Hogan Lovells blog post