AHA Comments on Co-Op Proposed Rule

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The American Hospital Association has issued a comment letter to CMS on its proposed rule for non-profit consumer operated and oriented health plans, outlining several proposed rules that it believes will inhibit the development of the plans, according to an AHA News Now report.

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

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