This article is more than 5 years old. Information may no longer be current.

CMS resumes ACA payments for insurers

CMS recently rescinded its decision to stop further collections or payments under the risk adjustment program.

The permanent risk adjustment program was established under the Affordable Care Act and provides payments funded by health insurance insurers that enroll low-risk populations to those that enroll high-risk populations to reduce incentives for avoiding high-risk enrollees, according to a press release issued by CMS.

Stopping risk adjustment payments would have left insurance premiums in limbo, jeopardized the Affordable Care Act and threatened the care of high-risk populations, such as those with chronic conditions, according to several experts who spoke with Healio.

The final rule reissues CMS’s risk adjustment methodology that was established for the 2017 benefit year, allowing the agency to resume its risk adjustment program in the individual and small group markets, according to the release.

“This rule will restore operation of the risk adjustment program, and mitigate some of the uncertainty caused by the New Mexico litigation,” Seema Verma, MPH, administrator of CMS, said in the release. “Issuers that had expressed concerns about having to withdraw from markets or becoming insolvent should be assured by our actions today. Alleviating concerns in the market helps to protect consumer choices.”

Immediate action was imperative to continue operation of the risk adjustment program, maintain stability and predictability in the individual and small group health insurance markets and preserve significant investments made by states, issuers and the federal government, according to CMS.

This final rule restarts he risk adjustment program without delay, according to CMS.

CMS also issued a Notice of Proposed Rulemaking to solicit comment on the its risk adjustment methodology that will apply to the 2018 benefit year, according to the release. – by Alaina Tedesco

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.