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September 03, 2015 at 11:33 AM
The U.S. Department of Health and Human Services (HHS) seems to be avoiding a battle over gender-based insurance premiums in a new batch of draft antidiscrimination regulations.
HHS officials have not put a provision clearly changing or expanding federal insurance pricing restriction in the proposal, Nondiscrimination in Health Programs and Activities (RIN 0945-AA02).
The HHS Office for Civil Rights and the HHS Office of the Secretary developed the new draft regulations to implement Section 1557 of the Patient Protection and Affordable Care Act of 2015. PPACA Section 1557 bans discrimination on the basis of race, color, national origin, sex, age or disability in “any health program or activity” that receives federal financial assistance.
See also: Lawmakers push for PPACA antidiscrimination regulations
Officials have proposed defining “health program or activity” to include “employee health benefit program,” and “employee health benefit program” to include “an employer-provided or sponsored wellness programs”; an “employer-provided health clinic”; or “long-term care coverage or insurance provided or administered by an employer, group health plan, third party administrator or health insurance issuer.”
See also: Group challenges gender-based LTCI rates
HHS could classify an entity as receiving federal financial assistance if it’s an HHS program, or if it’s an insurance company or other entity that participates in an HHS program, such as the Medicare Advantage program or the PPACA public health insurance exchange program. If any part of an entity received federal financial assistance, HHS would try to apply the antidiscrimination rules to all of the entity’s health-related operations.
If, for example, “XYZ Insurance Company” sold health insurance through the PPACA public exchange system, and XYZ also administered employer-funded wellness and long-term care plans for employers, HHS would try to apply the antidiscrimination rules to the wellness and LTC plan administration operations.
The proposed list of discriminatory actions prohibited includes efforts to discriminate by denying access to health coverage, limiting coverage, imposing additional cost-sharing requirements, or using discriminatory marketing practices. HHS would also ban any moves to shut out transgender individuals, or to keep transgender individuals from getting services related to their birth gender.
