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Third-Party Payments and Reference Pricing
Timothy Jost, in Health Affairs Link to more items from this source
[Guidance Overview]
May 22, 2014

"Neither the February 7 [HHS] FAQ nor the May 21 letter specifically bless payment by 'hospital-affiliated' foundations, but it seems that it would be difficult for HHS to challenge such payments in the wake of the May 21 letter.... [ACA FAQ Part XIX, issued May 2] addresses the use of reference pricing by large-employer and self-insured plans. It explicitly does not apply to non-grandfathered plans in the individual and small group market.... [T]he FAQ's endorsement of reference pricing is equivocal. The Departments express concern 'that such a pricing structure may be a subterfuge for the imposition of otherwise prohibited limitations on coverage, without ensuring access to quality care and an adequate network of providers.'"

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