CMS proposes risk adjustment payments for 2018

After halting, then restarting, payments for the healthcare insurance risk-adjustment program, CMS has proposed keeping the payments for the 2018 benefits rule. 

Previously, the agency restarted payments for the 2017 benefit year. The risk-adjustment payments program, designed as part of the Affordable Care Act, helps offset risk faced by insurers that accept higher-cost patients, by collecting payments from insurers with lower-risk patients and distributing funds to those who take higher-risk patients.

CMS halted payments and collections on July 7 due to a federal court decision that said the payment formula was based on flawed methodology. However, halting the payments posed a major threat to the stability of the healthcare insurance marketplace, and, after significant backlash from the industry, CMS reinstated the payments and published a final rule on July 30. The rule posted August 8 will ensure payments for the 2018 benefit year.

“Today’s proposed rule continues our effort to help stabilize the individual and small group markets,” CMS Administrator Seema Verma, MPH, said in a statement. “Our goal has been, and will continue to be, to stabilize the market and provide American consumers with more affordable health coverage options.” 

The 2018 proposed rule will be published on the Federal Register on Aug. 10, with a comment period that will run until Sept. 7.