Author Topic: New Pre-X Conditions  (Read 1542 times)


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New Pre-X Conditions
« on: July 01, 2010, 04:12:41 PM »
Immediate Action Item for Compliance Professionals: HHS Announces New Pre-Existing Condition Insurance Plan
Here's an immediate action item for compliance professionals.

HHS has just issued a fairly extensive press release about new insurance coverage for people with pre-existing conditions.  It lists which states' programs are being run by HHS, and which are going to be run by the states themselves.  The Press Release is at

Providers need to understand the plan in their state and get in front of the compliance and reimbursement issues and challenges that the plan will engender.  For example, there will be a need to understand the applicable standards, educate and train practitioners and billing personnel, put in new policies and procedures, etc.  Because this is a federally funded health program, each plan will generally carry the same legal and compliance risks as other federal plans. As the CMS press release explains:

The Pre-Existing Condition Insurance Plan will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs.  The Pre-Existing Condition Insurance Plan does not base eligibility on income and does not charge a higher premium because of a medical condition.  Participants will pay a premium that is not more than the standard individual health insurance premium in their state for insurance that covers major medical and prescription drug expenses with some cost-sharing.
Here's the urgency.  As the Press Release confirms:

Starting today, the national Pre-Existing Condition Insurance Plan will be open to applicants in the 21 states where HHS is operating the program. All states which are operating their own Pre-Existing Condition Insurance Plans will begin enrollment by the end of the summer, with many beginning enrollment today.
While it took more than 6 months for a small number of states to establish their CHIP programs, we anticipate that every state will begin enrolling individuals in the Pre-Existing Condition Plan by the end of August.

That means providers may have patients covered under such plans coming to their facilities within a few weeks of today.  Not much time to get it all together. . . .
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare