Officials at the Internal Revenue Service (IRS) have published documents that could shed a little light on how health insurers will pay the new, $1-per-enrollee Patient-Centered Outcomes Research Institute (PCORI) support fee.
The fee — created by sections 4375 and 4376 of the Internal Revenue Code (IRC), which were, in turn, created by the Section 6301 of the Patient Protection and Affordable Care Act (PPACA) — is supposed to help PCORI fund research aimed at showing which medical treatments work best, which are most affordable, and which seem to provide the best value.
PCORI can provide recommendations, but public and private insurers are not supposed to use those recommendations as the basis for making specific coverage decisions.
Insurers and self-insured plans are supposed to start paying the PCORI fee July 1.
In a set of answers to PCORI questions, IRS officials noted that affected plans can use any of three methods for counting enrollees, and that, for example, an employee and an employee’s child would count as two separate lives for PCORI purposes.
In a separate memorandum, Andrew Keyso, an IRS official, said he believes the PCORI fee is an excise tax that counts as an ordinary, necessary and deductible business expense.
- IRS completes health research fee regulations
- PPACA: IRS Proposes PCORI Fee Regulations
- The Catch: The Effectiveness Research Pie