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February 23 Hospital & Hospital Quality Open Door Forum Summary

Recovery Auditor Report, March 24, 2011

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Pre-existing condition insurance plans

A representative from the Centers of Consumer Information and Insurance Oversight informed the audience of a new health coverage option known as the pre-existing condition insurance plan (PCIP). PCIP, the representative explained, is a temporary high-risk health insurance pool that the federal government was required to establish per the Affordable Care Act. This option was designed particularly for people who have been shut out of the individual insurance market because of their medical condition. Beginning in 2014, all Americans will have access to affordable health plans, so this is being referred to as the “Bridge coverage plan.”

In 23 states (and in D.C.), PCIP is administered by the federal government. The remaining 27 states have opted to administer a PCIP themselves. To find out which plan a particular state is using, go to www.pcip.gov and click “find our state."

A CMS representative gave the audience an update on the provider enrollment screening final rule, generally referred to as “provider screening.” The rule requires that the secretary of Department of Health and Human Services determine what kind of screening should be conducted to enroll in Medicare according to the risk of fraud, waste and abuse with respect to categories of providers and suppliers.

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