The CO-OP plans, created by the healthcare reform law, will be developed by private non-profit entities, will promote care coordination and will offered through insurance exchanges. Integrated healthcare systems are eligible to develop the plans, and $3.8 billion in grant and loan funding is available from the federal government for CO-OP development.
While AHA supports the development of CO-OP plans, it is concerned the proposed rules may preclude integrated health networks because “as the proposed rules are written, for a provider organization to sponsor a CO-OP, it would have to accept financial responsibility for the plan but have little input into its governance and use of resources.” For example, the CO-OP and sponsoring entity cannot share a CEO or any board members. The AHA also calls on CMS to clarify its regulations regarding a sponsoring entity enrolling its own employees on the plan if its employees exceed the definition of small-group (50 members or less).
Related Articles on CO-OPs:
HHS: Up to 40% of Health Insurance Co-op Loans Could Default
CMS Releases Proposed Standards for CO-OP Insurance Plans
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
