► Minuteman Health NewsroomSeptember 23, 2016

Minuteman Health submits Freedom of Information Act requests as part of its Risk Adjustment lawsuit

BOSTON— Minuteman Health (www.minutemanhealth.org) has submitted Freedom of Information Act requests with the federal government in order to obtain information relative to the so-called “3Rs” – the risk corridor, reinsurance and risk adjustment programs. The 3Rs were designed to stabilize the insurance industry, but many believe that the 3Rs have instead resulted in significant market destabilization, premium increases, lessening of competition, and few lower-cost Bronze plan options.

In the FOIA submission to the Centers for Medicare & Medicaid Services, Minuteman Health requested:

 
  1. All documents relating to any criticism, challenge, or questions regarding the use of statewide average premium in the risk adjustment formula.
  2. All documents relating to any request or demand to set off risk corridors payments against risk adjustment assessments.
  3. All documents relating to whether bronze plans can be profitable under the risk adjustment formulas that have been used by HHS.
  4. All documents relating to whether the risk adjustment formulas used by HHS accurately measure the actuarial risk of enrollees without an HCC.
  5. All documents relating to whether the risk adjustment formulas used by HHS are an accurate predictor of actuarial risk and/or claims liability associated with each enrollee.
  6. All documents relating to CMS’ analysis of how the risk adjustment program was designed to or actually does improve or stabilize health insurance premiums and/or market stability.
  7. All documents relating to CMS’ evaluation of how the risk adjustment program actually impacted or will impact health insurance premiums and/or health insurance market stability.
  8. All documents relating to CMS’ evaluation of how the risk adjustment program impacts or could impact small, lower-cost and/or high-growth health insurers.
  9. All documents relating to CMS’ evaluation of how the risk adjustment program impacts or could impact issuers participating on the health insurance exchanges and/or issuers that do not participate on the health insurance exchanges.
  10. All documents relating to CMS’ evaluation of risk adjustment transfer payments as a percentage of health insurer surplus (regulated capital) for each health issuer that made or received a risk assessment transfer payment.
  11. All documents relating to CMS’ evaluation of payment of risk corridor amounts to issuers, including but not limited to CMS’ evaluation of its authority to “net”, or not to “net”, issuer risk corridor liabilities or receivables against other federal liabilities or receivables, including without limitation risk adjustment transfer payments, reinsurance payments, APTCs, and/or CSRs.
  12. All documents relating to communications with any state insurance regulator or other state regulatory entity regarding the risk adjustment and/or risk corridor programs.
  13. All documents relating to communications from or with any health insurance issuer regarding the risk adjustment methodology, including but not limited to flaws, challenges, or concerns with the methodology.
  14. All documents relating to communications from or with any health insurance issuer regarding the payment, offset, or “netting” of risk corridor payments.
 

The FOIA requests were filed July 18, 2016. CMS has 20 days to respond to the requests, but Minuteman has not yet received any answer to its FOIA requests and inquiries regarding the status of the FOIA requests have gone unanswered.

Minuteman in July filed a lawsuit in Boston federal district court against U.S. Health and Human Services (HHS) Secretary Sylvia Burwell, Centers for Medicaid and Medicare Services (CMS) administrator Andrew Slavitt and their respective agencies, claiming that the federal Risk Adjustment program has illegally cost Minuteman and its members millions of dollars.

As part of its effort to bring attention to inequities in the RA policy, Minuteman helped found CHOICES, a national coalition of health care plans organized to work with federal and state regulators on ideas for improving current Risk Adjustment formula. The recently released results of the 2015 Risk Adjustment program underscore CHOICES’ concern that the Risk Adjustment program destabilizes the insurance market.

About Minuteman

Minuteman Health, Inc. is 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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