Hospitals Paying COBRA Premiums to Assure Payment for Services?

The financial affect of the COVID-19 virus has prompted hundreds of thousands to lose their jobs and, together with it, their medical insurance. Electing to proceed protection by means of COBRA is an possibility, however many occasions an possibility that isn’t reasonably priced for folks with no revenue. Hospitals can now count on to see a surge of sufferers which are in precisely this place. Can a hospital choose to pay the sufferers’ COBRA premiums to be able to guarantee fee for its providers? The reply is that it is determined by the circumstances.

Public hospitals which are the regional “security internet” hospitals are required to just accept the affected person whatever the affected person’s potential to pay. If the affected person has no insurance coverage and isn’t capable of pay, the hospital has choices akin to enrolling the affected person in Medicaid if the affected person is eligible, or together with the affected person in 1 Be aware that this text tackle fee of COBRA premiums below employer-sponsored plans. It doesn’t tackle Federal Market particular person insurance policies, that are federally funded. its indigent care program. For these hospitals, paying the affected person’s COBRA premium wouldn’t be an try to draw the affected person to the hospital, for the reason that affected person have to be accepted no matter potential to pay. As an alternative, paying the COBRA premium could be simply one other strategy to guarantee that the hospital is paid for its providers.

Additional, as soon as the COBRA protection is in impact, the affected person could be free to get remedy at any facility of his/her selecting, assuming the hospital didn’t situation fee of the premium on being the affected person’s unique supplier. In reality, many hospitals brazenly make this their coverage. There can, nevertheless, be considerations that paying a affected person’s COBRA premiums is a means of inducing the affected person’s patronage.

Whereas the COBRA legislation is a federal legislation, COBRA insurance coverage isn’t a federal well being care program as a result of no a part of it’s paid for by state or federal {dollars}. Due to this fact, the federal well being care fraud and abuse legal guidelines that apply to Medicare and Medicaid will not be relevant to COBRA. And neither CMS nor the OIG has adopted an categorical prohibition on the follow of hospitals paying sufferers’ COBRA premiums.1 The IRS has, in its 1999 Closing Rule on Continuation Protection Necessities Relevant to Group Well being Plans, squarely addressed the difficulty by stating “Nothing within the statute requires the certified beneficiary to pay the quantity required by the plan; the statute merely permits the plan to require that fee be made.” They go on to state that “any individual could make the required fee on behalf of the certified beneficiary.”

To be clear although, that is solely the place of the IRS and never different governmental businesses.

The problem may rely on the state the hospital is in. States can have their very own well being care fraud and abuse legal guidelines which are relevant to business insurance coverage. Native well being care counsel ought to be consulted to find out if there are such legal guidelines and the way they affect this follow. If confronted with whether or not or not this could be permissible in your facility, issues would come with:

Whether or not or not paying the COBRA premiums is meant to induce affected person patronage versus simply assuring fee for providers.

Whether or not or not your facility accepts sufferers no matter potential to pay.

Whether or not or not your contracts with payers prohibit the follow. Any relevant state legislation.

The financial affect of the COVID-19 virus has prompted hundreds of thousands to lose their jobs and, together with it, their medical insurance. Electing to proceed protection by means of COBRA is an possibility, however many occasions an possibility that isn’t reasonably priced for folks with no revenue. Hospitals can now count on to see a surge of sufferers which are in precisely this place.

© Polsinelli PC, Polsinelli LLP in CaliforniaNationwide Legislation Assessment, Quantity X, Quantity 216