Health Affairs October 9, 2024
On October 4, 2024, the Department of Health and Human Services (HHS) published a proposed rule containing the 2026 HHS Notice of Benefit Payment Parameters and certain proposals related to the Basic Health Program. This article summarizes the proposed 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 proposed rule’s other provisions.
In brief, HHS largely proposes to continue its existing risk adjustment policies. However, it does break some notable new ground by proposing to account for receipt of HIV pre-exposure prophylaxis (PrEP) when calculating enrollee risk scores and by seeking public comment on how the risk adjustment program should account for the time value...
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