The American Hospital Association has asked CMS to change an interim final rule that lowered reimbursement rates under the agency's pre-existing condition insurance plan, according to an AHA News report.
The rule, which the agency issued in May, made the program's provider payment rates equivalent to Medicare reimbursements. If Medicare rates cannot be used, PCIP plans must pay 50 percent of billed charges or use a "relative value scale pricing methodology." Exceptions to the rule include prescription drugs, organ transplants, dialysis and durable medical equipment.
This payment rate reduction will cause confusion during the remainder of the PCIP program, AHA Executive Vice President Rick Pollack wrote in a letter to CMS Administrator Marilyn Tavenner. The AHA believes the program's reimbursement rates should be based on current Medicare Advantage out-of-network provider payment guidelines, Mr. Pollack wrote.
The lower PCIP rates are related to funding reductions due to fiscal policy changes such as sequestration. The program took effect under the Patient Protection and Affordable Care Act in June 2010 and will end Jan. 1, 2014, when the PPACA will prohibit health plans from refusing to cover individuals with pre-existing conditions.
More on the PCIP Program:
HHS: Pre-Existing Condition Insurance Plan Rates to Match Medicare
A Rich New Source of Patient Payment: PCIP
Health Law Provides Coverage to 50k Patients With Pre-Existing Conditions