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CMS urged to clarify PCIP payment rule

July 26, 2013

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The AHA last week urged the Centers for Medicare & Medicaid Services (CMS) to revise an interim final rule that reduced provider payment rates for the Pre-existing Condition Insurance Plan in an attempt to stretch appropri­ated funds until the program expires Jan. 1. “The AHA is disappointed that the rate reduction was issued without input from the provider community and did not provide a sufficient definition of the rate that will be paid to providers,” wrote AHA Executive Vice President Rick Pollack.

“We believe this will lead to confusion during these remaining months of the program.”

Pollack said the simplest way to remedy the problem would be to base payment on the Medicare Advantage out-ofnetwork provider payment
guidelines, which were updated in December. Beginning Jan. 1, health plans will be prohibited from imposing pre-existing condition limitations in their policies under the “Patient Protection and Affordable Care Act.” For more on the AHA’s July 19 letter, click on: http://tinyurl.com/mesu3a5.