Understanding the Patient-Centered Outcome Research Institute (PCORI) Fee

The Patient-Centered Outcome Research Fee (PCORI Fee) was first authorized under the Affordable Care Act (ACA) in 2010. This fee helps fund research that helps patients and healthcare providers make more informed decisions about the care they provide and receive. Though originally scheduled to sunset in 2020, additional legislation extended the application of the PCORI for another decade.

The PCORI Fee is charged to employers who offer self-insured plans. The fee is applied to plan years ending on or after October 1, 2012, and before October 1, 2029, and is calculated based on the number of covered lives under the plan. Employers use IRS Form 720 to pay this fee, indicating quarter ending June 30 (even though this is an annual fee). IRS Notice 2022-59 outlines the current fees:

• For plan years that ended on or after Oct. 1, 2022, and before Oct. 1, 2023, (including calendar year plans), the fee is $3.00 per person covered by the plan, up from $2.79 a year earlier.

• For plan years that ended on or after Oct. 1, 2021, and before Oct. 1, 2022, the fee is $2.79 per person, up from $2.66 the year before.

Employers who offer self-insured plans are responsible for paying the PCORI Fee directly to the IRS. Employers with fully insured health plans rely on their carrier ro pay this fee. A health reimbursement account (HRA) is a self insured plan for PCORI purposes, even when paired with a fully insured medical plan. This means employers offering an HRA alongside their fully insured medical plan will pay the PCORI fee directly to the IRS, while their medical carrier pays the fee applicable to the medical plan.

The annual July 31 deadline is quickly approaching, so its a good time to review the Form 720 instructions, collect data from carriers and vendors and prepare the applicable fee at this time.