Letter to Marilyn Tavenner, Administrator of the Centers for Medicare and Medicaid Services - Non-Profit Patient Assistance Programs

Letter

June 16, 2014
Honorable Marilyn Tavenner
Administrator
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-9943-IFC
P.O. Box 8016
Baltimore, MD 21244-8016

Dear Administrator Tavenner:

We are disappointed in the Center for Medicare and Medicaid Services' (CMS) communication with the American Hospital Association (AHA) issued on May 21, 2014, which failed to apply the standard with regards to third party payments from non-profit charity organizations used by Medicare to the new Exchange plans.

Although the rule provides explicit clarification of the acceptability of premium and cost-sharing payments made on behalf of enrollees by the Ryan White HIV/AIDS Program, other Federal and State government programs that provide premium and cost sharing support for specific individuals, and Indian tribes, tribal organizations, and urban Indian organizations, it does not speak at all to the issue of non-profit patient assistance programs.

This has caused the same amount of uncertainty as the administration's interim rule which states, "our new standard does not prevent qualified health plans (QHPs) and stand-alone dental plans (SADPs) from having contractual prohibitions on accepting payments and cost sharing from third party payers other than those specified in this interim final regulation." As a result, Obamacare plans are continuing to interpret this as permission to prohibit acceptance of third party private charity payments, and therefore leaving the most vulnerable populations at risk of losing access to care.

The fact that the Centers for Medicare and Medicaid Services (CMS) is somehow spinning this as a change of heart on the treatment of third party payers to prevent public backlash is not only dishonest but is resulting in a snowball effect preventing patients in multiple states from using charities as a resource to secure health care services. Health plans in states with a high volume of uninsured patients like Louisiana and New York are denying the benefit of third party payers, making it more difficult to afford higher premiums under the Exchange and avoid the penalty under the individual mandate.

As the Administrator of CMS you have seen the benefit of empowering non-profit charity organizations to offer assistance to patients in need of health services in the Medicare program. We ask that you reconsider your recent decision and allow patients to access third party payments from charity organizations in the same manner seniors have successfully secured access to health care under the Medicare program.

Sincerely,

David Vitter
United States Senate

Bill Cassidy
United States House of Representatives

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