CMS Changes Documentation Rules for Pre-Existing Conditions

As of May 1, 2012, the federally-administered Pre-Existing Condition Insurance Plan will no longer accept documentation from hospitals or other healthcare providers as proof of a pre-existing condition, according to a memo from CMS (pdf).

The PCIP, part of the Patient Protection and Affordable Care Act, is the program that requires health insurance companies to provide coverage to people with pre-existing conditions, such as cancer and heart disease.


Instead, applicants who are 19 or older can submit a denial letter from a health insurer, a denial letter from a license insurance agent or broker or an offer of coverage letter.

CMS changed the documentation requirements as it plans to administer the PCIP in a "steady state approach."

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