Administration relaxes some health care rules, asks insurers to be flexible

McClatchy Washington BureauDecember 12, 2013 

— In yet another acknowledgment of the difficulties Americans have faced purchasing coverage through the HealthCare.gov website, the Obama administration on Thursday announced that it would grant a one-month extension for a transitional federal program that provides health coverage to people with serious illnesses.

In addition, the administration has put forward a handful of new requirements and recommendations for marketplace insurers to make it easier for people to get coverage that begins on Jan. 1.

As the administration tries to overcome the disastrous rollout of the HealthCare.gov website, the new proposals and requirements could add further confusion to an already complex potpourri of deadlines, mandates and recommendations surrounding the controversial health care law.

The transitional insurance program, known as the Pre-Existing Condition Insurance Plan, or PCIP, was supposed to expire on Jan. 1 when new Affordable Care Act rules take effect requiring insurers in the individual market to offer coverage to all people, regardless of their current or past health status.

The nearly 88,000 people in the pre-existing condition program – which includes stroke victims, cancer sufferers and people with major heart disease – were supposed to transition into new marketplace coverage next month.

But technical problems with the website have kept thousands of people from accessing coverage. Extending the pre-existing condition coverage by another month gives this vulnerable population more time to select and enroll in a plan.

“We don’t want these folks to experience a coverage gap,” Health and Human Services Secretary Kathleen Sebelius said Thursday during a telephone press briefing.

The pre-existing condition program already has cost more than $4.7 billion, but HHS officials believe there’s enough cash left to extend coverage through January. Sebelius is also asking marketplace insurers to give all consumers more time to pay their first month’s premium for coverage that begins on Jan. 1.

Because of technical problems with the federal marketplace website, the administration already had given consumers an extra eight days – until 11:59 p.m. on Dec. 23 – to enroll in coverage that starts on Jan. 1. That change was finalized on Thursday through new rules that give consumers until Dec. 31 to make their first month’s premium payment on the new coverage.

But Sebelius is asking insurers to be even more flexible.

“We’re recommending that health insurers extend this (Dec. 31 payment) deadline further,” she said Thursday.

She’s also asking that insurers begin coverage for consumers on Jan. 1 even if they’ve only made a partial payment on the first month’s premium.

“We’re encouraging insurers to allow consumers who paid portions of their premium, such as a down payment, to be able to start their coverage on time,” the health secretary said.

Consumers who enrolled in marketplace coverage that begins on Jan. 1 are urged to contact their insurers to make sure their coverage has been properly processed.

Sebelius said the administration is also requiring insurers to post up-to-date provider directories and a list of covered medications on the state and federal marketplaces. And it is “strongly encouraging” insurers to allow their new plan members to continue filling prescriptions that were allowed under their old plans through the end of January.

Additionally, the Obama administration would like insurers to treat out-of-network care providers as network participants to assure continuity of care for new plan members with acute medical episodes. It wants out-of-network providers to be treated as “in-network” if they were originally listed as in-network during the open enrollment period, but their status has subsequently changed.

The administration is also encouraging insurers to offer “retroactive coverage” that would allow, for instance, someone who paid for coverage on Jan. 5, 2014, to have the coverage start date listed as Jan. 1. This would allow income-eligible consumers to qualify for federal subsidies to help pay for their January coverage, said Michael Hash, director of the HHS Office of Health Reform.

Aetna has already agreed to begin coverage for new members on Jan. 1, even if payments come as late as Jan. 8, said Chiquita Brooks-Lasure, deputy director for policy and regulation at HHS’ Center for Consumer Information and Insurance Oversight.

The new recommendations mainly apply to insurers on the federal marketplace that serves 36 states.

The 14 states that run their own marketplaces will make their own decisions about whether to follow the new HHS recommendations, said Brooks-Lasure.

Administration officials said they have worked closely with the insurance industry on the new proposals. Hash said the flurry of new changes and accommodations are not uncommon requests for insurers when people are transitioning into new coverage.

Email: tpugh@mcclatchydc.com; Twitter: @TonyPughDC

Ledger-Enquirer is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts.

Commenting FAQs | Terms of Service