The proposed rules would establish a temporary state-based reinsurance program, a temporary federal risk corridor program that would protect health plans against inaccurate rate setting and a permanent state-based risk adjustment program.
The AHA made three recommendations on the proposed rule:
• For each of the three risk mitigation programs, all notices regarding methodologies should be made public with a sufficient period of time allowed for review and comment.
• Health plans should be prohibited from passing on to providers the losses from pro rata reduced payments when the reinsurance program in inadequately funded. The AHA said a pro rata approach could put pressure on health plans to recoup losses from providers treating high-cost cases.
• States should comply with federal regulations when collecting encounter-level data.
Related Articles on AHA:
AHA Releases Report Outlining Key Strategies, Competencies for Long-Term Success
AHA Calls Give Providers Opportunity to Discuss RAC Process Issues
AHA Tells Supercommittee to Reject Proposals That Undermine Medicaid
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
