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In December, 2012, the final regulations on the Patient-Centered Outcomes Research Institute (PCORI) were released. The PCORI is an institute designed to “assist patients, clinicians, purchasers, and policymakers in making informed health decisions by advancing the quality and relevance of evidence-based medicine through the synthesis and dissemination of comparative clinical effectiveness research findings.” It is funded by the Patient-Centered Outcomes Research Trust Fund, which is funded, in part, by fees that are paid by health insurance issuers and sponsors of self-insured health plans (the PCORI fee).
In this client alert, the authors examine the PCORI fee as applied to self-insured health plan sponsors. Ultimately, they urge plan sponsors to begin preparing for the fee by (a) reviewing each of their health plans and determining whether the PCORI fee applies, (b) examining the three available methods for calculating the average number of lives covered and deciding which method is the most practical (or, if utilizing the transition rule for the first year of the PCORI fee, using a reasonable counting alternative), and (c) counting the covered lives under the chosen method.