Ama Policy

Health Insurance Exchange and 90-Day Grace Period H-185.938

Prompt Payment Deadlines

1. Our AMA opposes the preemption of state law by federal laws relating to the federal grace period for subsidized health benefit exchange enrollees, and will seek appropriate changes to federal law and regulations to protect state and prompt payment laws.

2. Our AMA will advocate that health plans be required to notify physicians that a patient is in the federal grace period for subsidized health benefit exchange enrollees upon an eligibility verification check by the physician. The notification must specify which month of the grace period a patient is in. Failure to notify physicians of patient grace period status would result in a binding eligibility determination upon the insurer.

3. Our AMA will continue to advocate that plans be required to pay providers for all claims for services rendered that would otherwise be covered under the contract during a grace period.

4. Our AMA will take all possible means available to change the current federal rule permitting the pending of claims during the grace period.

5. Our AMA will vigorously support state societies in their legal attempts to enforce prompt pay statutes and rules during grace periods.

6. Our AMA supports the development of alternative financing solutions, such as reinsurance for unpaid premiums, for physician payments during the grace period.

Policy Timeline

Sub. Res. 813, I-13Modified: Res. 707, A-14Reaffirmation I-15