ACA risk adjustment fix reportedly in the works

Large insurers, many of which are owed millions of dollars in risk-adjusted payments for 2017, called for CMS to quickly devise an alternative.

The details of the interim final rule and how it will address risk-adjusted payments, however, remain unknown. 

The legal dispute that triggered the freeze was U.S. District Judge James Browning's ruling in February that the payment's methodology was based on flawed calculations. Browning determined CMS would need to justify its math through a rule that's subject to public comment. 

The title of the interim rule pending review, "Ratification and Reissuance of the Methodology for the HHS-operated Permanent Risk Adjustment Program under the Patient Protection and ACA," suggests it will address exactly that. 

That should please large players in the insurance industry like Blue Cross Blue Shield Association, whose CEO Scott Serota called the CMS decision to freeze the payments a recipe for "turmoil" for insurers and small businesses in the small group market and predicted it would "undermine Americans' access to affordable coverage." 

For smaller insurers like Molina and Centene, each of which would have avoided $1 billion in payments into the risk-adjustment pool for 2017, that respite might be coming to an end.


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