News: CMS proposes rule to address risk adjustment program for 2018 benefit year

A couple weeks after CMS unfroze risk-adjustment payments under the Affordable Care Act (ACA) for benefit year 2017, CMS has now released a proposed rule that would essentially extend this decision into benefit year 2018.

The permanent risk-adjustment program, created under the ACA, transfers funds from health plans with lower-risk enrollees to plans with higher-risk enrollees to spread the financial risk and help stabilize premiums, according to AHA News. CMS expects the proposed rule to provide $9.6 billion in risk-adjustment transfers for benefit year 2018.

Last week the agency finalized the current methodology for calculating risk-adjustment transfers in the individual and small group health insurance markets for benefit year 2018.

CMS will accept comments on the use of statewide average premiums through Friday, September 7.

Editor’s note: To read about the initial freeze and the precipitating events, click here. To read about CMS unfreezing payments for the 2017 benefit year, click here. To read about the CMS press release, click here. To read the AHA News coverage of this story, click here.