Daily Archives: May 20, 2013

Covered by PCIP/Federal risk pool?

News you can use: Feds post PCIP regs | LifeHealthPro.

Effective June 15th:

The federal PCIP program run by the U.S. Department of Health and Human Services (HHS) will set most reimbursement levels at just 100 percent of the Medicare reimbursement rates, officials said in a new interim final rule that is set to appear in the Federal Register May 22.

In situations in which federal PCIP managers cannot use Medicare provider reimbursement rates to set rates, PCIP managers will pay either 50 percent of billed charges or an amount set using a “relative value scale pricing methodology,” officials said.

The new payment rules will not apply to prescription drugs, organ transplants, dialysis services or durable medical equipment.

Why is this happening?

The managers of the PCIP program have to take emergency steps to cut reimbursement costs, because Congress allocated only $5 billion for the program, the money is running out, PCIP already has done everything else it can think of to cut costs, and Congress seems to be unwilling to provide any more funding, officials said in the preamble to the rule.

Once again, why is this happening?

Because the Federal Government knows absolutely nothing about running an insurance company or the concept of “adverse selection”. This program was vastly undersubscribed compared to expectations yet it obviously ran substantially over budget.