In the July 30, 2010 Federal Register, the DHHS Office of Consumer Information and Insurance Oversight issued an interim final rule (75 Fed. Reg. 45014) setting forth the rules for the new “Pre-Existing Condition Insurance Plan Program” called for under the healthcare reform law.  The Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148) set aside $5 billion for the creation of temporary high-risk pools for people with pre-existing conditions as an interim measure to ensure affordable health insurance coverage before the new state-based exchanges get underway in 2014.  The rule addresses administration of the program, eligibility and enrollment, benefits, premiums, funding, and appeals and oversight requirements. Most states have opted to participate in the high-risk pool program, with a majority of those choosing to operate their own programs, rather than having DHHS do so for them. White House Office of Health Reform Director Nancy DeParle issued a statement that coverage under the high-risk pool program will be available at the same rate as it is for an average person who does not have a pre-existing condition.  She noted that beginning in 2014, discrimination against anyone with a pre-existing condition will be illegal under the PPACA. Under the rule, DeParle said that covered benefits include hospitalization, outpatient care, maternity care, hospice, and home healthcare.

About Sam Fish

Sam Fish has over 40 years of legal experience in federal and state human services laws and programs, having joined PCG in 1995 after serving as Chief Counsel, Region I, for the U.S. Department of Health and Human Services for more than 25 years. At PCG, Sam provides legal advice and counsel and has served on many projects that required legal research and interpretation and implementation of many federal and state laws. He has also participated in in-house training in new litigation areas, including Temporary Assistance for Needy Families (TANF), the Balanced Budget Act (BBA), and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). He is available for legal guidance in program areas including school-based billing, third-party liability, Olmstead implementation, and Medicare and Medicaid reimbursement. Currently, he is providing guidance and counsel in the interpretation and implementation of the new health care legislation.

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