October 16, 2013
Members of the California Medical Association (CMA) House of Delegates took a stance on the 90-day grace period provision called for in the Affordable Care Act (ACA), an issue that has been rapidly evolving in response to CMA's continued advocacy.
The resolution (Res. 402-13) was amended by delegates during floor debate this weekend to reflect recent state and federal actions regarding the grace period provision. The resolution, as adopted by the House, calls for heightened standards for information provided to physicians regarding enrollees in the state's health benefit exchange, as well as a provision emphasizing CMA's position that physicians should not be compelled by payors to participate in exchange products.
As initially proposed, the ACA's grace period posed considerable risk to physicians participating in exchange products, potentially exposing them to two months of suspended and/or denied claims if a patient is delinquent on their insurance premiums. Recently, however, California's Department of Managed Health Care has asserted that patients falling under the grace period provision would have coverage suspended after the first 30 days, and that insurance companies could not represent this coverage as active to the participating physician. The patient would then have the second and third months to pay the premium balance and have coverage reinstated.
Given that the grace period provision has been a concern to physicians across the country and California is the only state thus far to move forward on the suspension of coverage issue, the matter was also referred to the American Medical Association for national action.