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CMS prepares to make PPACA risk corridors payments

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The Centers for Medicare & Medicaid Services (CMS) could begin issuing the first risk corridors program payments for the 2014 coverage year in a few weeks.

Officials at CMS talked about the Patient Protection and Affordable Care Act (PPACA) risk corridors program payment schedule Tuesday in a note posted on the semiprivate RegTAP technical assistance website.

“Currently, CMS is targeting December to begin making risk corridors payments,” officials said in the note. 

See also: Feds: “We’ll send some PPACA lifeboat money in December”

CMS will use a manual process payment report to record any payments made before Jan. 1, officials said.

The agency will use the HIX 820 electronic data interchange process to send any program payments made on or after Jan. 1, and it will use the payment type code “RC” to identify any program payments made though that process, officials said.

The risk corridors program is supposed to use cash from PPACA plan issuers that do well in the 2014, 2015 and 2016 coverage years to help issuers that do poorly during those years.

PPACA drafters created the program in an effort to encourage insurers to sell coverage through the exchange system, and to keep premiums as low as possible. CMS officials recently announced that the program may take in only enough cash from thriving insurers to pay about 13 percent of the risk corridors program obligations.

See also: Feds: PPACA risk program may pay just 13% of 2014 claims

Regulators of several new nonprofit, member-owned health carriers created with PPACA startup loans have said they will have to suspend sales in 2016 due to the risk corridors program funding shortfall.

See also: Colorado regulators move to decertify state’s CO-OP


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