Ramping up the controversy surrounding the Affordable Care Act’s risk adjustment program, two more health insurers have sued the federal government over what they see is a flawed formula that unfairly ...

Newly finalized regulations from the federal government create a “next generation risk adjustment model” aimed at stabilizing the Affordable Care Act marketplaces. On Friday, the Centers for Medicare ...

Worcester-based Fallon Health and two other insurance plans have asked the state’s Health Connector Insurance Authority to review risk assessment fees that they say could financially impact smaller ...

In future rulemaking, the Centers for Medicare and Medicaid Services will propose that all issuers fund a small payment to the risk adjustment program to help marketplace insurers with high claims ...

Risk adjustment payments correlated for 2014 correlated highly with reinsurance program payments, showing that risk adjustment payments were going to insurers with high-cost cases; Risk adjustment ...

To maximize shared savings, mastering risk adjustment is a critical factor for Accountable Care Organizations (ACOs) participating in MSSP, ACO REACH, and other alternative payment models.

We collaborate with the world's leading lawyers to deliver news tailored for you. Sign Up for any (or all) of our 25+ Newsletters. Some states have laws and ethical rules regarding solicitation and ...

On December 31, 2019, a three-judge panel of the Tenth Circuit Court of Appeals upheld the methodology adopted by the Department of Health and Human Services (HHS) to administer the risk adjustment ...

For health plans serving the individual market, the Affordable Care Act’s risk adjustment program generally worked as intended to shift funds from insurers with low-cost enrollees to plans with ...

In a new final rule, CMS reissued the Affordable Care Act's risk adjustment program for payers in the ACA exchanges for the 2018 benefit year. The reissue includes an additional explanation of the ...