CMS Cracks Down on Obamacare Subsidy Verifications

The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule, “Patient Protection and Affordable Care Act (PPACA): Exchange Program Integrity.”

This proposal, CMS says, would safeguard taxpayer dollars by ensuring that people are accurately determined eligible for premium subsidies they receive through the Exchange.  In addition, to better align federal regulations with statutory requirements and congressional intent, the rule proposes that issuers must send a separate bill and collect separate payments for the portion of the consumer’s premium attributable to certain abortion services for which public funding is prohibited.

“This administration is committed to making sure taxpayer dollars are spent appropriately,” said CMS Administrator Seema Verma.  “Maintaining a high level of program integrity on the Exchange is essential, including ensuring that premium tax credits only go to those who are eligible for them. This proposed rule represents CMS’ commitment, consistent with the law, to continuously improve and strengthen oversight over the programs we administer on behalf of the American taxpayer.”

The proposed rule would address several recommendations based on audits of both State and Federal Exchanges by the Office of Inspector General (OIG) and the Government Accountability Office (GAO) identifying substantial weaknesses in the process for determining eligibility for advance payments of the premium tax credit (APTCs) and cost-sharing reductions (CSRs), according to the CMS announcement.

With this proposal CMS says it is demonstrating its commitment to protecting the consumer and the integrity of the Exchange by ensuring the correct people are being identified as eligible for subsidies.  CMS recently took action to review the eligibility determination processes used by state Medicaid programs and says it is now working to address the integrity of the Exchange eligibility determination process.

NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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