The Centers for Medicare & Medicaid Services expects to begin $10.4 billion in risk adjustment transfers for benefit year 2017 in September, according to a final rule posted last night. The permanent risk adjustment program, created by the Affordable Care Act, transfers funds in the individual and small group health insurance markets from health plans with lower-risk enrollees to plans with higher-risk enrollees to spread the financial risk and help stabilize premiums. On July 9, CMS announced that the transfers were on hold due to litigation. In February, a federal district court in New Mexico invalidated CMS’s use of the statewide average premium in the risk adjustment transfer formula for the 2014-2018 benefit years, pending further explanation of the agency’s reasons for operating the program in a budget neutral manner in those years. The final rule adopts the previously published methodology for the 2017 benefit year with additional explanation. The agency said it intends to issue a new proposed rule on the risk adjustment methodology for the 2018 benefit year. Twenty-eight health care organizations, including the AHA, last week urged CMS to reconsider its decision to suspend the risk adjustment transfers.

Related News Articles

Headline
The House May 22 passed the fiscal year 2025 budget reconciliation bill, the One Big Beautiful Bill Act by a 215-214 vote. The legislation includes significant…
Headline
The AHA May 21 voiced support to Senate and House sponsors of the Improving Seniors’ Timely Access to Care Act, legislation that would reduce the variation in…
Headline
The Department of Health and Human Services May 20 announced it has identified specific pricing targets for pharmaceutical manufacturers to meet to satisfy…
Perspective
Public
Three key House committees — Energy and Commerce, Ways and Means, and Agriculture — after long debates and discussions this week advanced their portions of a…
Headline
The Centers for Medicare & Medicaid Services May 12 released draft guidance for the third round of negotiations for the Medicare Drug Price Negotiation…
Headline
Zaira Khalid, M.D., senior staff geriatric psychiatrist at Henry Ford Behavioral Health Hospital, discusses the unique physical, emotional and social needs of…