Managers of the Pre-existing Condition Insurance Plan (PCIP) say health care providers will have to share some of the program’s financial pain.
The federal PCIP program run by the U.S. Department of Health and Human Services (HHS) will set most reimbursement levels at just 100 percent of the Medicare reimbursement rates, officials said in a new interim final rule that is set to appear in the Federal Register May 22.
In situations in which federal PCIP managers cannot use Medicare provider reimbursement rates to set rates, PCIP managers will pay either 50 percent of billed charges or an amount set using a “relative value scale pricing methodology,” officials said.
The new payment rules will not apply to prescription drugs, organ transplants, dialysis services or durable medical equipment.
Another provision in the final rule will prohibit providers from “balance billing,” or billing patients for the difference between the amount PCIP will pay and the amount the provider wants to collect.
The rule is set to take effect June 15.
Comments will be due 60 days after the Federal Register publication date.
The managers of the PCIP program have to take emergency steps to cut reimbursement costs, because Congress allocated only $5 billion for the program, the money is running out, PCIP already has done everything else it can think of to cut costs, and Congress seems to be unwilling to provide any more funding, officials said in the preamble to the rule.
“Based on estimates, HHS believes it is prudent and necessary to make additional adjustments in the federally-administered PCIP with respect to payment rates for covered services in order to ensure that there is sufficient funding available to provide coverage to currently enrolled individuals until the program ends in 2014,” officials said.