News: CMS may restart ACA risk adjustment payments, unfreezing $10.4 billion

Roughly two weeks after CMS suspended $10.4 billion in risk adjustment payments to insurers, the agency signaled last week that it may reverse course, according to HealthLeaders Media.  

While CMS is currently reviewing all its options, according to HealthLeaders Media, an interim rule CMS sent to the Office of Management and Budget for review suggests that one option could be to restart the program.

The title of the interim rule—“Ratification and Reissuance of the Methodology for the HHS-operated Permanent Risk Adjustment Program under the Patient Protection and Affordable Care Act”—indicates that CMS is looking to recalibrate the way it calculates payments. CMS’ critics have argued that the agency should have done this first anyway, instead of halting the payments all together.

Andy Slavitt, former CMS administrator under President Barack Obama, said that drafting an interim final rule would easily solve the problem, according to HealthLeaders Media. Slavitt described the payment frees as “aggressive and needless sabotage” on Twitter.

Because it’s labeled as an interim final rule, the item could take effect immediately, HealthLeaders Media reported.

Editor’s note: This article was originally published in HealthLeaders Media. To read the original story about the payment freeze, click here. To read the interim final rule, click here. To learn about the various risk adjustment models, click here. To learn how CDI can assist with risk adjustment, click here.