The Centers for Medicare and Medicaid Services has issued an interim final rule setting payment rates for treatment of patients enrolled in the federal government’s Pre-Existing Condition Insurance Plan authorized under the Affordable Care Act.
The rule also prohibits providers from charging enrollees in the federal pre-existing plan from an amount greater than the enrollees’ out-of-pocket costs, beginning June 15. The Pre-Existing Condition Insurance Plan is a temporary program serving as bridge to provide coverage to individuals previously locked out of insurance until 2014 when most insurers are required to offer such coverage. About 135,000 individuals with pre-existing conditions have joined the program since enrollment began in 2010.
In 2012, the average annual claims cost paid per enrollee was $32,108, according to CMS. “This cost per enrollee exceeds even that of state high risk pools that predate the Affordable Care Act for several reasons,” according to the interim final rule. “Like other high risk pools, PCIP enrollees are limited to people that were previously considered uninsurable due to high expected claims cost. In contrast to many state high risk pools, PCIP enrollees do not experience any waiting periods or pre-existing condition exclusions upon enrollment in the program.”
The interim final rule is available here.
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