Thursday, November 3, 2011

BCBSNC announces PPACA comparative effectiveness research fees to take effect

Under the Affordable Care Act of 2010 (ACA), health insurance issuers and sponsors of self-funded group health plans will be assessed an annual fee to fund comparative effectiveness research. The fee is imposed beginning in 2012 and ending in 2019. Revenue from this fee will fund research to determine the effectiveness of various forms of medical treatment.

In the first year, the amount of the assessment is $1 times the average number of covered lives under the plan for policy years ending on or after September 30, 2012. This means a group with an effective date beginning on or after October 2, 2011 would be subject to this fee. The fee increases to $2 per participant in 2013. In the years following 2013, the fee will be an amount indexed to national health expenditures thereafter.

Blue Cross and Blue Shield of North Carolina (BCBSNC) will comply with this requirement of ACA.
Here’s what you need to know about the requirements:
• BCBSNC will charge the fee to fully-insured groups with an effective date beginning after October 2, 2011.
• Policyholders with individual medical coverage will be assessed this fee beginning on January 1, 2012. It will be built into their 2012 rates.
• ASO groups are responsible for paying the fee directly.

For More Information on Comparative Effectiveness Research
Please see the frequently asked questions below for additional information on comparative effectiveness research and our implementation of these requirements. These websites are also good resources for more information.

BCBSNC Spotlight on Comparative Effectiveness Research: http://www.bcbsnc.com/assets/hcr/pdfs/spotlight_cer.pdf
Medicare Physician Compare Website: http://www.medicare.gov/find-a-doctor/provider-search.aspx
RAND Analysis of Comparative Effectiveness Research: http://www.randcompare.org/analysis-of-options/analysis-of-comparative-effectiveness
Kaiser Family Foundation Comparative Effectiveness Research: http://www.kff.org/healthreform/upload/7946.pdf
Agency for Healthcare Research and Quality: http://www.effectivehealthcare.ahrq.gov/index.cfm/what-is-comparative-effectiveness-research1/
BCBSA TEC: http://www.bcbs.com/blueresources/tec/

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