The Washington Report

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August 15, 2018

Legislative

House Adjourns for Summer; Senate Returns Next Week

The House is on summer recess and will return to the Hill after Labor Day. The Senate will reconvene on August 15 after an abbreviated August recess. The Senate’s agenda is expected to include voting on judicial confirmations and work on a spending package that combines appropriations for the Departments of Defense, Labor, and Health & Human Services.

Health

CMS Issues Proposed Regulations on Risk-Adjustment Program

On August 9, 2018, the Centers for Medicare & Medicaid Services (CMS) of the Department of Health & Human Services (HHS) issued proposed regulations that adopt the risk-adjustment methodology that the HHS previously established for the 2018 benefit year. That risk-adjustment methodology uses the statewide average premium in the payment transfer formula. The risk-adjustment program under the Affordable Care Act provides payments to health insurance issuers that enroll higher-risk populations, such as those with chronic conditions.

In February 2018, a federal district court vacated the use of the statewide average premium in the HHS-operated risk-adjustment methodology for the 2014 through 2018 benefit years. As the CMS explains in the preamble to the proposed regulations, the court did so because the HHS had not adequately explained why it was adopting a methodology to keep the program budget neutral. In the proposed regulations, the CMS provides additional explanation and proposes to adopt the HHS-operated risk-adjustment methodology for the 2018 benefit year as established in final rules it issued in March 2012 and December 2016.

Comments must be received by September 7, 2018.

The proposed regulations are available here.

A CMS press release is available here.