CMS may be mulling restarting insurance risk-adjustment payments

The federal Centers for Medicare and Medicaid Services may soon restart making billions of dollars in risk-adjustment payments to insurance companies with plans on the individual market via a new rule making (Source: “Trump Administration Preparing Fix for Obamacare Risk Payments,” Bloomberg News, July 19, 2018).

The agency on Wednesday sent an interim final rule related to the payments to the White House Office of Management and Budget for review. 

It's unclear what exactly the rule will do. However, health policy insiders say there are clues in the rule's name: "Ratification and Reissuance of the Methodology for the HHS-operated Permanent Risk Adjustment Program under the Patient Protection and Affordable Care Act."

CMS does not comment on pending regulation under review at the OMB, according to a spokesperson. 

The agency halted the payments earlier this month, citing a federal judge's ruling in New Mexico earlier this year. U.S. District Judge James Browning determined the agency did not adequately justify its payment methodology for the payments and it needed to do so via rulemaking that's subject to public comment.

CMS has said that until that legal conflict is resolved it can't make the payments or receive adjustments from insurers. All in all, the agency was slated to shift $10.4 billion among exchange insurers for 2017.