Health Affairs April 9, 2024
On April 2, 2024, the Department of Health and Human Services (HHS) and the Department of the Treasury published a final rule that includes the final 2025 HHS Notice of Benefit Payment Parameters and certain other provisions. Most of the provisions of the final rule have been summarized in a prior article by Sabrina Corlette and Jason Levitis. This article examines provisions related to the individual and small group market risk adjustment programs. The final rule continues existing risk adjustment policies for the 2025 benefit year with narrow exceptions, mirroring HHS’ original proposals.
Risk Score Model Updates
The individual and small group market risk adjustment system relies on a set of regression models that assign risk scores to enrollees based...
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