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HHS issues PCIP, MLR rules

May 17, 2013

The Department of Health and Human Services today released an interim final rule setting payment rates for covered services furnished to individuals enrolled in the Pre-Existing Condition Insurance Plan program administered by the department beginning with covered services furnished on or after June 15. The rule will require providers to accept Medicare rates for services provided to PCIP participants in those states where the federal government operates the program. The rule also will prohibit balance billing. AHA staff are analyzing the rule, which will be published in the May 22 Federal Register, and members will receive a Special Bulletin with further detail on Monday. The Centers for Medicare & Medicaid Services today also released a final rule implementing the medical loss ratio requirements for the Medicare Advantage Program and the Medicare Prescription Drug Benefit Program established under the Patient Protection and Affordable Care Act.