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GAO: HHS needs congressional OK to make 2015 risk corridors payments

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The U.S. Department of Health and Human Services (HHS) may need to get approval from Congress to operate one of the three major new federal health insurance risk-management programs in fiscal year 2015.

Susan Poling, general counsel at the U.S. Government Accountability Office (GAO), comes to that conclusion in a letter to Sen. Jeff Sessions R-Ala., and Rep. Fred Upton, R-Mich.

The Patient Protection and Affordable Care Act (PPACA) requires HHS run a temporary “risk corridors” program. The program is supposed to use cash from health insurers with good underwriting results to help PPACA exchange plan issuers with poor underwriting results.

The money that HHS would collect from the successful insurers is a kind of user fee, and HHS did have explicit appropriation act authority to spend risk corridors program user fees on payments to exchange plan issuers in fiscal year 2014, Poling writes.

The fiscal year 2014 ended Sept. 30.

The appropriation provision that allowed that spending was temporary, and HHS needs need appropriation authorization from Congress to spend the risk corridors program user fees on the program for the 2015 fiscal year, Poling writes.