Feds order insurers to accept payments from AIDS program

The Centers for Medicare & Medicaid Services Friday ordered insurers to accept premium payments from a federal program that helps HIV/AIDs patients cover their health care costs.

The interim rule requires insurers to immediately begin accepting third-party payments for premiums and cost sharing for Ryan White HIV/AIDS programs, according to CMS. The rule also covers payments from Indian tribes, tribal organizations and urban Indian organizations, and state and federal government programs for enrollees in the individual online insurance marketplaces.

On Monday, three of the Louisiana health insurance companies that offer coverage through the Obamacare marketplace agreed to accept the payments through Nov. 15.

In February, Blue Cross and Blue Shield of Louisiana announced it would stop taking third-party payments in an effort to prevent fraud. Blue Cross said CMS had advised insurers in November against accepting any third-party payments.

HIV/AIDS organizations and others had criticized Blue Cross’ decision. Critics claimed Blue Cross had chosen to deliberately misunderstand CMS. The decision affected an estimated 2,000 people with HIV/AIDS.

John East, a New Orleans resident, filed a federal lawsuit Feb. 20 against Blue Cross, Vantage Health Plan Inc. of Monroe and Louisiana Health Cooperative of New Orleans, alleging the companies illegally discriminated against people with HIV/AIDS. East is represented by Lambda Legal, an HIV/AIDS advocacy nonprofit. East’s lawsuit said the companies violated the Affordable Care Act by refusing to accept premium payments from the Ryan White program.

Kenneth Upton Jr., senior counsel in Lambda’s Dallas office, applauded the CMS ruling.

“The way forward is clear. Lower-income people with HIV in Louisiana should go sign up for insurance,” Upton said. “This is great news.”

Blue Cross spokesman John Maginnis said Friday the insurer received the CMS rule and intends to comply with the requirements.

Attorneys for all three of the insurers said Monday the companies would accept the payments if CMS ordered the payments be accepted.

CMS officials said Friday if insurers refuse to accept the payments, they may have to pay a penalty.

If an insurer refuses to comply with the rule, CMS said the organizations that submitted the payments or the people affected should contact the agency through the Health Insurance Marketplace Call Center.