Health Affairs February 5, 2025
On January 13, 2025, the Department of Health and Human Services (HHS) published a final rule that contained the 2026 HHS Notice of Benefit Payment Parameters and certain policy changes related to the Basic Health Program. This article summarizes the rule’s provisions related to the individual and small group market risk adjustment programs; a companion article by Sabrina Corlette and Jason Levitis summarizes the rule’s other provisions. The final rule largely continues existing risk adjustment policies, but it does finalize some notable policy changes, including beginning to account for receipt of HIV pre-exposure prophylaxis (PrEP) when determining enrollee risk scores. The policies finalized by HHS in the final rule almost exactly mirror its proposals from the October proposed rule.
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