The Center for Consumer Information and Insurance Oversight (CCIIO) may be giving more attention to concerns about auditing and fraud in new Pre-existing Condition Insurance Plan (PCIP) contracting materials.
Congress created the $5 billion PCIP program to give people with serious health problems a way to buy coverage. The sick people who use the program can get major medical coverage for a price comparable to the price that healthy people in their states pay. In 2012, claims averaged about $30,000 per enrollee.
Officials at CCIIO — pronounced “Sih-Sigh-Oh” — startled the administrators of state-run PCIP plans in February by announcing that CCIIO was shutting down new enrollment in federally run PCIP plans immediately and in state-run plans in just two weeks.
The Associated Press reported last week that CCIIO managers have suggested that the PCIP program as a whole will run out of cash before the date when it is supposed to shut down — Dec. 31 — and that states will have to make up the difference between what CCIIO can pay for the program and the actual cost of the covered claims.
Now CCIIO, the arm of the Centers for Medicare & Medicaid Services (CMS) responsible for helping the U.S. Department of Health and Human Services (HHS) implement many of the provisions of the Patient Protection and Affordable Care Act (PPACA) that affect the private health insurance market, has posted a batch of updated PCIP contract documents.
The updated documents are on the CMS website under the form number CMS-10339 (2013).
The original PCIP contract documents are on the Web at at CMS-10319 (2010).
CCIIO has posted the revised documents because the documents are going through a routine paperwork review process.