► Minuteman Health NewsroomAugust 9, 2016

Minuteman Health Files Risk Adjustment Reconsideration Request with Massachusetts Connector

BOSTON—Minuteman Health (www.minutemanhealth.org) has formally asked the state Connector Authority to reconsider the approximately $6 million the company has been ordered to pay other Massachusetts carriers under the Risk Adjustment policy for the 2015 coverage year. The Connector oversees the federal risk adjustment program in Massachusetts.

Minuteman is a national leader in the effort to improve the Risk Adjustment formula, which the company claims illegally punishes small, more efficient companies and hurts consumers seeking lower-priced coverage plans. The company recently filed a lawsuit against the federal government seeking changes in the formula. The lawsuit asks the court to invalidate the Risk Adjustment methodology and to require the federal government to implement needed changes immediately.

In its request for consideration filed in Massachusetts, the company outlined six flaws in the Connector’s 2015 payment assessment:

 

  1. The data used to calculate Minuteman’s Risk Adjustment payment is flawed and unreliable.
  2. Through use of the so-called “statewide average premium,” the Connector penalizes Minuteman for offering an efficient, low-cost network of providers. For plan year 2015, this penalty – basically, a non-legislated tax levied by CMS – amounted to about $377.23 per Minuteman Massachusetts member, a total of $2,016,290.
  3. The Connector penalizes Minuteman for having relatively more members with zero Hierarchical Condition Category (HCC) codes. A recent white paper authored by the former Chief Actuary of CMS highlights this concern: “The current HHS-HCC risk adjustment model established by CMS is known to understate risk scores for relatively healthy individuals and to overstate them for those with significant health conditions.” http://www.choicescoalition.org/documents/HHS HCC RA model bias adjustment memorandum.pdf
  4. The Connector penalizes Minuteman for having more Bronze members. CMS data as well as issuer experience highlights that the Risk Adjustment formula categorically penalizes issuers that sell Bronze products by ensuring that those insurers always pay out Risk Adjustment money on Bronze products.chart.pnghttps://www.regtap.info/uploads/library/RA_ConferenceSlides_033116_5CR_040516.pdf
  5. The Connector failed to properly account for partial-year enrollment, causing issuers with a large number of enrollees enrolled for fewer than twelve months to be penalized. In addition, the Connector has admitted that its methodology has no partial year adjustment factor for Bronze or Catastrophic products.
  6. The Connector failed to incorporate prescription data. As a result, the calculated Risk Scores do not accurately reflect actual member health status.

Minuteman last year filed a request for reconsideration for the 2014 coverage year. That request was denied by the Connector. Minuteman appealed the decision and is awaiting a hearing.

About Minuteman

Minuteman Health, Inc. is a member-governed, non-profit health maintenance organization (HMO) committed to removing inefficiencies from today’s health insurance system to provide high-quality care, cut administrative costs and reduce premiums for individuals and businesses in Massachusetts and New Hampshire.

Minuteman Health’s In-Plan Provider network includes over 11,300 hospitals, physicians, and specialists who provide high quality care at lower costs in Massachusetts and New Hampshire. Updates on Minuteman Health’s evolving provider network can be found at www.minutemanhealth.org.

Minuteman is marketed in Massachusetts through its website, brokers, Health Services Administrators (www.HSAinsurance.com) and the Massachusetts Health Connector. It is marketing in New Hampshire through its website, brokers, and the Federal Healthcare Exchange.

 

About CHOICES

CHOICES members are non-profit as well as investor-owned, health system-sponsored and independent, and newer entrants as well as companies with decades of experience as members of their local communities. The group came together to examine what gaps may exist between the policy intent and the practical reality of the ‘3Rs’ programs today. Such gaps are to be expected in any launch of a new methodology, and CHOICES looks forward to continuing to work productively with CMS to replace old assumptions with the current data.

CHOICES founding members include Minuteman Health, Health New England (Massachusetts), HealthyCT (Connecticut), Land of Lincoln (Illiniois), Melody Health Care (Colorado), New Mexico Health Connections, Evergreen Health (Maryland), Bright Health Plans (Minnesota), Cox Health Plans (Missouri), Medical Associates Health Plans (Iowa), and the National Alliance of State Health CO-OPS (NASHCO).
 
 

Media Contact:
Jim Borghesani
617-833-9327

jim@pri-media.com
 

Lisa McTighe
Director of Marketing and Communications
855-644-1776

lisamctighe@minutemanhealth.org

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