PCORI Fee: FAQs - Zupnick Associates

PCORI – What It Is?

The Patient-Centered Outsource Research Institute is, according to their own site, “an independent, non-profit research organization created to help patients and those who care for them make better informed health decisions”. 

PCORI was founded in 2010, and has used its $3 billion+ to fund nearly 2,000 research studies and projects so far. Below are some of the most common frequently asked questions about PCORI.

Here are some commonly asked questions regarding the PCORI fee.

FAQs

What is the PCORI rate for 20[insert year]?

The PCORI rate changes each year, like taxes. In 2017 it was $2.26, while in 2019 it was $2.54. Double check with your compliance manager to know for sure. 

Who is responsible for paying the PCORI fee?

Employers employing (we’re so punny) a self-funded insurance plan for their employees are responsible for paying the PCORI fee, per employee. 

Is there a penalty for failing to pay the PCORI fee / paying it on time?

The PCORI schedule usually offers two accepted payment windows, with the later one being a few centers higher than the “on-time” one. However, if you fail to file PCORI altogether, your penalty can be up to 5% of the original amount owed – penalized monthly, and capped at 25% of the original amount owed. 

What is PCORI’s official policy on cost and cost-effectiveness?

PCORI allows proposed studies to gather data detailing direct measurement of the cost related to patients, caregivers, and other stakeholders. However, PCORI does not allow research that compares care costs among multiple alternative approaches to offering care.

What is the distinction between a Dual PI and a Co-PI?

A Dual PI refers to an award in which the prime institution has appointed two persons as principal investigators (PIs) who share equally the responsibility and authority for directing and leading the project. It’s necessary to have a formal leadership plan for a Dual PI role.

On the other hand, a Co-PI is a person recognized by the PI and the prime institution as sharing administrative and scientific leadership responsibilities for a research project with the PI. 

What’s the eligibility for the PCORI funding application?

Applications for PCROI funding may be submitted by nonprofit research organizations and for-profit research organizations in the private sector as well as universities, colleges, laboratories, manufacturers, healthcare systems, hospitals, federal government units, state government units, and local government units. 

The IRS must recognize all US organizations that apply, and individuals can’t apply. 

Non-domestic units of US organizations and foreign organizations must prove that the research will benefit the US healthcare system, that the plans of engagement include US stakeholders and patients, and apply to the US healthcare system.

What research is funded by PCORI?

PCORI funds patient-focused research to help patients, caregivers, and clinicians make better healthcare decisions. It finances comparative clinical effectiveness research to determine which clinical approaches or options are most favorable to patients and their caregivers, depending on their specific characteristics and concerns. 

What research isn’t funded by PCORI? 

There are research proposals that PCORI deems nonresponsive and doesn’t fund, including instrumental development like scales and surveys; comparison of patient attributes instead of clinical strategy options; pilot studies for informing more significant efforts; and development, testing, and validation of new clinical prognostication tools.

The institute also refuses to fund research with findings that include coverage recommendations, basic science or biological mechanism study, policy or payment recommendations, formation of clinical practice guidelines, pharmacodynamics, the study of a disease’s natural history, and the foundation of success for a new clinical strategy.

What’s the fast-track resubmission process, and what are the selection criteria?

 

In 2022, PCORI lets specific applicants amend and resubmit their application before the next available due date, enabling them to bypass the letter of intent stage of the application process. Selected applicants can amend and resubmit their application a cycle earlier than the traditional funding processes. At PCORI’s discretion, eligible applicants are picked according to these criteria: their applications must score over 50 at the in-person merit review panel forum, and the applications must address a priority area or a special area of emphasis in PCORI’s research portfolio.

When can PCORI funding recipients start incurring expenses for their project?

In cost-reimbursement contracts, expenses may be incurred up to 90 days before the contract’s start date but not before the date of the announcement of the award by the Board of Governors of PCORI. 

Can the award recipient transfer the award to another organization? 

Yes, as long as PCORI approves the transfer. A principal investigator looking to transfer a contract must offer notice and obtain written approval from the initial organization. 

How does PCORI announce an award?

After completing the merit review process, PCORI emails the applicants to invite them to a Board of Governors webinar, where awards are announced. The email has the date, time, and details of registration. PCORI will send an email notification to award recipients one day before the webinar. After the webinar, the institute will inform all applicants via email if they got the funding and offer summary statements with scores. 

 

And, as usual, if you’re looking for experienced, professional insurance brokers, with a propensity for savings, get in touch with the Zupnick team today!

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