July 26, 2018
CMS released a final rule on risk adjustment for the 2017 benefit year (aimed to address the courts’ concerns that halted risk adjustment payments)
Key highlights from this short rule:
· Methodology the same as originally finalized in the 2017 Payment Notice
· Collections will start in September (11-13th), Payments will start in October (22nd). This is a delay.
CMS also announced that a new proposed rule will be forthcoming to propose a methodology for the 2018 benefit year (emergency rules are legally risky so there is logic in that it only addresses the 2017 benefit year). It also announced that the 2019 methodology (given the payment notice language) should be considered final.
Legislation Watch
The House moved on multiple health-related topics this past week including a 2-year moratorium for the health insurance tax (2020 and 2021) and repeal of the Medical Device tax. The Senate is unlikely to take up these bills until after the midterm elections. Similarly, legislation aimed at opioid abuse is also likely to wait in the Senate until after the midterms.
Legal Watch
New York and Massachusetts have sued the Federal government to block the Association Health Plan final rule. More to come…
Medicare
CMS released a far reaching proposed regulation this week that reduces payment differences for site of services. In particular, “CMS is proposing to exercise authority under the law to control unnecessary increases in the volume of covered hospital outpatient department services by applying a Physician Fee Schedule (PFS)-equivalent payment rate for the clinic visit service when provided at an off-campus provider-based department (PBD) that is paid under the OPP”. This is expected to be opposed by providers.
Research of the Day
About one-third of all plans sold on the Marketplace are offered in only part of a rating area. Why do issuers do this? The researchers found that it is primarily driven by issuers’ desire to screen risk. You can read the paper here.