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A move over the weekend by the federal agency that regulates the Affordable Care Act halted payments intended to stabilize the national health care program, but the decision should not have been delayed. Immediate impact on Kansas businesses or beneficiaries. 19659002] The Centers for Medicare and Medicaid announced Saturday that, due to a court ruling in February at the New Mexico District Court, the agency would suspend $ 10.4 billion in transfers from expected risk for the 2017 benefit year. The court found that the formula used to determine the risk adjustment payments was flawed. These payments were put in place within the framework of the ACA to balance the risks taken by the health insurance companies, transferring funds from issuers presenting a low actuarial risk to those presenting an actuarial risk. high.
In other words, The amounts and Company B of the same risk group had low claim amounts, Company B would be subject to a risk adjustment charge that would be paid to A. 19659002] Although the announcement surprised some in the industry after the February court ruling, Kansas insurance industry executives have stated that they did not expect that stopping these payments would be a significant problem.
"We will continue to collect more information.will change the rates we would submit to the Insurance Commissioner by the end of the week," said Mary Beth Chambers, Blue spokeswoman Cross Blue Shield of Kansas
. as a market in 103 counties. Medica Insurance Co. offers plans in 105 counties, and Sunflower State Health Plan Inc. in two.
Medica spokesperson Greg Bury said in an e-mailed statement, "We are monitoring the situation closely." Julie Holmes, Director of Health and Life for the Kansas Insurance Department, said the announcement had been made recently and that the court would quickly look into CMS's request to re-examine the record. "
" It's a risk adjustment program, so some carriers will receive and others will pay, "she said."
But if the lack of adjustment payment could compromise a company's willingness to provide a health insurance in the state, the situation could change.
"I think the stabilization of the market is a concern," Holmes id. "We will just have to see. I think it's premature to know what the impact will be until we know it will last. "
In the national arena, some groups were not as restricted in their concerns.
" We are extremely disappointed that the administration froze the transfer of payments under the program Risk-adjusting Affordable Care Act, which aims to reduce costs for consumers while meeting the medical needs of those requiring significant care, "said Scott Serota, President and CEO of Blue Cross Blue Shield. . A quick resolution to this problem, this action will significantly increase the premiums for 2019 for millions of individuals and small business owners and could result in far fewer choices of health plans. This will jeopardize Americans' access to affordable coverage, especially for those who are most in need of medical care. "
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