New Guidance On CSR Payments And Risk Adjustment: Answers … And More Questions

The ongoing saga of the cost-sharing reductions just got stranger. On August 10, 2017, the Centers for Medicare and Medicaid Services released at their REGTAP.info website a guidance on risk adjustment methodology and rate filing deadlines. The guidance states “At this time, there have been no changes regarding HHS’s ability to make cost-sharing reduction payments to issuers.” But “[m]any state departments of insurance (DOIs) have permitted issuers to increase rates for their silver metal level plans for the 2018 benefit year in order to account for uncompensated liability that issuers may face for cost-sharing reductions provided to eligible individuals.” Because of this, CMS intends to modify its risk adjustment methodology in future rulemaking for marketplace insurers that increase their silver plan rates “to account for cost-sharing reduction payments in this manner.” Moreover, to allow states to permit insurers to modify their 2018 rates to account for this, HHH is delaying its deadline for rate filing modifications to September 5, with final determinations on qualified health plan rates due on September 20 and final QHP rate tables due September 25. In other words, HHS may stop reimbursing insurers for reducing cost sharing for low-income consumers at some undetermined point in the future—it has not yet decided. This despite the fact that the ACA requires the payments; insurers, the National Association of Insurance Commissioners, the National Governors ...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Following the ACA Insurance and Coverage cost-sharing reduction payments risk adjustment Source Type: blogs