CMS To Continue Risk Adjustment Payments Despite Ongoing Litigation

CMS issued a final rule on 2018 risk adjustment methodology that explains the agency’s reasoning for running the program in a budget-neutral manner and responds to an ongoing court case that challenges the agency’s decision-making. The agency expects to provide issuers $4.8 billion in risk adjustment transfers for the 2018 benefit year. In February, a New Mexico Judge had ruled that CMS violated the Administrative Procedure Act and blocked the agency from using the statewide average premium to calculate risk...