HHS said if Medicare reimbursement rates cannot be used, then PCIP plans must pay 50 percent of billed charges or use a “relative value scale pricing methodology.” The rule does not apply to prescription medications, organ transplants, dialysis or durable medical equipment.
The lower reimbursement rates are related to shrunken funding due to changes in fiscal policy, such as sequestration, according to the rule. The agency will accept comments on the rule through 60 days after the rule is entered into the Federal Register, expected Wednesday.
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