CMS finalizes rule to provide $4.8 billion in 2018 risk-adjustment transfers

The Centers for Medicare & Medicaid Services today issued a maintaining the current methodology for calculating risk-adjustment transfers in the individual and small group health insurance markets for benefit year 2018. CMS expects the rule to provide $4.8 billion in risk-adjustment transfers for benefit year 2018. The permanent risk-adjustment program, created by the Affordable Care Act, transfers funds from health plans with lower-risk enrollees to plans with higher-risk enrollees to spread the financial risk and help stabilize premiums. In February, a federal district court in New Mexico invalidated CMS鈥檚 use of the statewide average premium in the transfer formula for the 2014-2018 benefit years, pending further explanation of the agency鈥檚 reasons for operating the program in a budget-neutral manner. 鈥淎lthough the litigation is still pending, we are issuing this final rule to preserve the consistent, ongoing operation of the Risk Adjustment program for the 2018 benefit year,鈥 . AHA had urged CMS to finalize the proposed rule as soon as possible.