Health & Welfare Plans Newsletter

April 9, 2018

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[Official Guidance]

HHS-Developed Risk Adjustment Model Algorithm 'Do It Yourself (DIY)' Software Instructions for the 2018 Benefit Year (PDF)
24 pages. "The methodology that HHS will use when operating a risk adjustment program on behalf of a State for the 2018 benefit year will calculate a plan average risk score for each covered plan based upon the relative risk of the plan's enrollees, and apply a payment transfer formula in order to determine risk adjustment payments and charges for plans within a State market risk pool. The HHS risk adjustment methodology addresses three considerations: [1] adverse selection in the individual and small group markets; [2] plan metal level differences and permissible rating variation; and [3] the need for risk adjustment transfers that net to zero." [Also available: Technical Details [.xlsx file, 976KB] 2018 Benefit Year Risk Adjustment SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (.zip file, 1MB)]
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]

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4/29-5/2/2018 in Washington DC. This event brings together Employers, Brokers, and TPAs. Qualified HR & Benefits Professionals may attend as our guest - See website for details/restrictions & to apply.


Small Employers Cut Health Care Costs Using Stand-Alone HRAs
"More than 70 percent of small businesses using a new type of health reimbursement arrangement (HRA) last year did so to offer employee health benefits for the first time ... These early adopters also spent less on health benefits than small employers that provide employees with group health coverage."
Society for Human Resource Management [SHRM]

HHS Moves to Enforce Conscience Rights of Health Care Providers, Plan Sponsors
"The proposed health care conscience rules ... will give employers and other health plan sponsors that want to purchase group health insurance without abortion coverage the right to file complaints with the OCR challenging the state insurance rules that require abortion coverage in their policies. [T]he OCR may be able to require states to face the choice of either allowing the sale of health insurance without abortion coverage or lose their FFA for health care programs like Medicaid."
Wolters Kluwer; free registration required

Two Ways Employers Should Push ACO Arrangements to Evolve
"Payers' ability to change provider behavior is likely to be negligible if they only reward providers with small bonuses for effective care a year after the fact. Greater financial accountability would encourage providers to promote preventive care and look for ways to cut waste.... Commercial payers can modify patients' out-of-pocket spending to encourage them to seek care only within the ACO."
Health Affairs

Iowa Is Latest State to Challenge ACA Through Noncompliant Plans
"Iowa's new law would permit Iowa's Farm Bureau to partner with a designated insurance company to create self-funded health benefit 'arrangements' that are not technically health insurance plans, thus allowing these 'arrangements' to avoid state regulation and ACA mandates like essential health benefits. Under the law, these plans are to be 'sponsored by a nonprofit agricultural organization . . . [and] shall be deemed not to be insurance.' Tennessee permits a similar process."
Pepper Hamilton LLP

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Will States Step in to Stabilize ACA Marketplaces?
"With the repeal of the ACA's individual mandate expected to cause some destabilization and rising premiums in the small and individual marketplaces, a number of states are considering their own actions to bolster the market.... While destabilization of the individual market does not directly impact employers, these state-based efforts could translate to increased administrative costs in tracking state requirements as well as additional reporting responsibilities."
Conduent

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BenefitsLink Health & Welfare Plans Newsletter, ISSN no. 1536-9595. Copyright 2018 BenefitsLink.com, Inc. All materials contained in this newsletter are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior written permission of BenefitsLink.com, Inc., or in the case of third party materials, the owner of those materials. You may not alter or remove any trademark, copyright or other notices from copies of the content.

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