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The Trump administration has announced that it is resuming Obamacare’s risk adjustment program – just two weeks after it had frozen payments to insurers participating in the Affordable Care Act (ACA) healthcare market.
Billions of dollars in insurer payments were temporarily halted by the Centers for Medicare & Medicaid Services (CMS) two weeks ago, citing a federal district court decision in New Mexico four months ago that ruled that the formula used to calculate the payments was “flawed.”
According to the federal decision in February 2018, the Department of Health and Human Services “did not adequately explain its decision” to adopt a methodology that used the statewide average premium as a basis for cost-scaling. The decision came as detractors of the ACA argued that the risk adjustment program penalized smaller startup health plans.
However, CMS yesterday issued a final rule that the agency said clarifies the program methodology, as well as addresses other issues raised by the federal decision, POLITICO reported. Thanks to the final rule, charges can be collected and payments can be made for the 2017 benefit year.
“Issuers that had expressed concerns about having to withdraw from markets or becoming insolvent should be assured by our actions today,” CMS administrator Seema Verma said in a statement.
