BOSTON— Minuteman Health (www.minutemanhealth.org) Chief Executive Officer Thomas Policelli today urged Massachusetts and New Hampshire regulators to consider adopting an approach similar to the recently-announced “market stabilization pool” being created in New York to help mitigate the adverse impact of payments ordered under the federal Risk Adjustment program.
The New York program, announced earlier this month by the Department of Financial Services (DFS), would direct a portion of the money received by insurers under the Risk Adjustment program into a fund administered by DFS. The department would then transfer money to insurers that paid into the Risk Adjustment program and were adversely impacted. DFS would calculate the payments based on its own “estimate of the amount of the imbalance” caused by the federal regulations.
That amount would not exceed 30 percent of what an insurer received in Risk Adjustment payments. The New York regulation would apply only to the small group market for the 2017 plan year.
Policelli said the New York plan represents a step forward for regulators struggling to mitigate the impact of the current federal program on smaller, more efficient plans like Minuteman.
“New York is putting forward an admirable attempt to bring some fairness and balance into a system that at this point is punishing smaller, more efficient plans for being smaller, more efficient plans. We’ve said all along the Risk Adjustment can work, but the current federal formula falls considerably short in its goal of creating and maintaining a stable marketplace. We think the New York model is certainly something that local regulators should study and consider,” Policelli said.
Minuteman was ordered to pay $16.6 million to other Massachusetts and New Hampshire carriers under the recent Risk Adjustment assessment.
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.
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.
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).
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