Health & Welfare Plans Newsletter

BULLETIN
Supplement to
August 8, 2018

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[Official Guidance]

Text of CMS Proposed Regs: Adoption of the Methodology for the HHS-Operated Permanent Risk Adjustment Program for the 2018 Benefit Year (PDF)

18 pages. "This rule proposes to adopt the risk adjustment methodology that HHS previously established for the 2018 benefit year. In February 2018, a district court vacated the use of statewide average premium in the HHS-operated risk adjustment methodology for the 2014 through 2018 benefit years. HHS is proposing to adopt the HHS-operated risk adjustment methodology for the 2018 benefit year as established in the final rules published in the March 23, 2012 Federal Register and the December 22, 2016 Federal Register.... [C]omments must be received ... no later than 5:00 p.m. on September 7, 2018."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

[Guidance Overview]

CMS Issues Proposed Additional Rule to Address Risk Adjustment Program for the 2018 Benefit Year

"This proposed rule further explains the justification for utilizing statewide average premium in the calculation of risk adjustment transfers, and expands on the reasoning behind operating the HHS-operated risk adjustment program in a budget-neutral manner. CMS seeks comment on the proposal to use statewide average premium in the risk adjustment methodology for the 2018 benefit year.

Previously, CMS issued a final rule which adopted the risk adjustment methodology that CMS formerly established for transfers related to the 2017 benefit year, so that HHS could continue operation of the program to maintain stability and predictability in the individual and small group health insurance markets. However, the rule only allows for the program to continue for the 2017 benefit year. The rule proposed today would allow the program to continue for the 2018 benefit year."
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2018 BenefitsLink.com, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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