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Chief Healthcare Executive December 21, 2024
The 2021 Proposed Payment Notice, Part 3: Risk Adjustment
Health Affairs February 3, 2020
On January 31, 2020, the Centers for Medicare and Medicaid Services (CMS) released its proposed 2021 Notice of Benefit and Payment Parameters rule. Prior posts addressed the rule’s changes related to insurers (e.g., plan benefits, market reforms, and special enrollment periods) and exchanges (e.g., the automatic reenrollment process and termination of exchange coverage). This post covers the proposed changes to the risk adjustment program.
Overview
The ACA included three premium stabilization programs: risk corridors, reinsurance, and risk adjustment. The risk corridor and reinsurance programs lasted from 2014 to 2016. The third premium stabilization program, risk adjustment, continues, and much of the final rule is devoted to the program’s proposed parameters for 2021.
The risk adjustment program transfers funds from lower-risk,...
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