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April 16, 2015 at 11:33 AM
Health insurers in many states will have to file major medical rates for 2016 before they know how the three Patient Protection and Affordable Care Act (PPACA) risk-management programs really work.
Officials at the Center for Consumer Information & Insurance Oversight (CCIIO) have given the insurers a summary of the PPACA rate review and risk-management program rules and calendars in two new batches of guidance.
CCIIO is a unit of the Centers for Medicare & Medicaid Services (CMS), which, in turn, is a unit of the U.S. Department of Health and Human Services (HHS). CCIIO runs the PPACA exchange programs in many states, and it runs PPACA rate review programs in many states.
The U.S. Supreme Court may hand down a ruling on King vs. Burwell (Case Number 14-114), a case that could have a major effect on individual market pricing in some states, in late June.
CCIIO says it will start giving insurers details about the payments and charges stemming from the PPACA temporary reinsurance program, the PPACA temporary risk corridors program and the PPACA permanent risk-adjustment program — three PPACA programs that could have a major effect on pricing — this summer.
The reinsurance program is supposed to help PPACA-compliant plans pay the bills of enrollees with catastrophic claims in 2014, 2015 and 2016. The risk corridors program is supposed to use cash from issuers with good underwriting results in those three years to help issuers with bad underwriting results. The risk-adjustment program is supposed to use cash from plans with low-risk enrollees to help plans with high-risk enrollees.
CCIIO notices showing how much issuers will get, or pay, the risk-adjustment and reinsurance programs for the 2014 plan year are supposed to go out by June 30.
See also: Feds post PPACA reinsurance program data
