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CMS Releases Risk Pool Grant Rule

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The federal Centers for Medicare & Medicaid Services has completed work on a regulation that affects the state-sponsored pools that insure residents who have difficulty getting commercial health coverage.

The CMS originally published interim risk pool regulations July 27, 2007.

Because no one commented on the interim rule, the CMS has implemented the provisions of the interim rule in the final rule without making any changes, officials write today in a notice that appears in the Federal Register.

The interim rule expanded the definition of a “qualified high risk pool” to include any risk pool in a state that finds a way to provide health coverage for all individuals who are entitled to have access to health coverage under the Health Insurance Portability and Accountability Act of 1996.

In the past, a risk pool could qualify only if the risk pool itself accepted all HIPAA-eligible individuals.

The interim definition also permitted U.S. territories to qualify for risk pool grants, and it increased the maximum amount that a qualifying pool could charge to 200% of the standard risk rate, from 150%.

Other changes adjusted the funding allotment formula and removed the limitation that a state’s grant not exceed 50% of the pool’s operating losses, officials write.

HYPERLINK “”A copy of the final rule is available here.


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