Filed Under:Health Insurance, Individual Health

CMS posts risk-management proposals

CMS Acting Director Marilyn Tavenner
CMS Acting Director Marilyn Tavenner

The Centers for Medicare & Medicaid Services (CMS) has proposed 373 pages of regulations that could affect how health plans fund and draw from new, multi-billion-dollar risk-management programs.

The proposed "notice of benefit and payment parameter" regulations also could affect how CMS, an arm of the U.S. Department of Health and Human Services (HHS), handles other responsibilities created by the Patient Protection and Affordable Care Act of 2010 (PPACA), such as running the PPACA individual exchanges, or Web-based health insurance supermarkets, and the health insurance exchange program for small businesses -- the Small Business Health Option Program (SHOP).

Some commenters who responded to CMS requests for comments said letting employees choose plans at different metal levels could increase adverse selection risk, or the risk that sicker employees will flock to certain health plans, or certain types of plans.

"There was general agreement among ... commenters that the degree of risk segmentation is small if employee choice is limited to a single metal level of coverage, particularly given the presence of risk adjustment, and increases as employee choice is extended across metal levels of coverage," officials said. "Many commenters suggested that the risk segmentation associated with broad choice across all metal levels may adversely affect premiums."

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Nichole Morford

Nichole Morford
Managing Editor

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