July 2018

This week, the Centers for Medicare and Medicaid Services (CMS) issued a final rule to readopt the risk adjustment methodology for the 2017 plan year. With this new rule, CMS will resume the risk adjustment program and begin collecting and paying out about $10.4 billion in risk adjustment transfers for 2017. For a summary of the final rule, check out this Health Affairs blog post.

In light of the federal district court’s decision in Stewart v. Azar, the Centers for Medicare and Medicaid Services (CMS) announced it is re-opening the comment period for Kentucky’s Section 1115 waiver application, which included work/community engagement requirements. In the announcement, CMS noted that “[a]lthough an additional public comment period is not legally required, CMS is conducting one to ensure that interested stakeholders have an opportunity to comment on the issues raised in the litigation and in the court’s decision.” The agency is accepting comments through August 18, 2018. To learn more about the Stewart v. Azar decision and its implications for states, join us for our upcoming webinar (see below for the link to register).

This week, the Centers for Medicare and Medicaid Services (CMS) issued a press release announcing the suspension of about $10.4 billion in risk adjustment (RA) payments for 2017 until litigation around the federal RA program is resolved. The announcement was in response to a February 2018 New Mexico district court ruling that the government’s methodology for implementing the RA program was “arbitrary and capricious.” For a summary of the press release and its related implications, check out this Health Affairs blog post and a blog post by our friend and colleague, Sabrina Corlette from Georgetown University.

This week, the Centers for Medicare and Medicaid Services (CMS) released a series of three new reports on marketplace enrollment and trends. The reports include data on: Effectuated Exchange enrollment for 2017 and 2018; overall trends on the operational and programmatic performance of the Exchange, and trends in subsidized and unsubsidized individual market enrollment from 2014 to 2017. A comprehensive summary of the reports, including details on the role of agents and brokers, can be found in this Health Affairs blog post.

The cost of health care was the subject of a hearing this week held by the Committee on Health, Education, Labor and Pensions. In case you missed it, you can watch a recording. The hearing was the first in a series on how to reduce the cost of health care in the United States and featured testimony from Niall Brennan, head of the Health Care Cost Institute, who argued that price increases are to blame for rising costs rather than an increase in the utilization of care. Also on the topic of the cost of health care in the U.S., Leavitt Partners released a report this week, the product of a combined quantitative and qualitative analysis of factors that may be influencing total cost of care in health care markets across the United States.