The Centers for Medicare and Medicaid Services on Friday issued the final rule for insurers in the marketplace in creating a next generation risk adjustment model.
The new risk adjustment model accounts for a number of factors, including the number of individuals who had a marketplace plan for less than a year, and the risk of high-cost patients. It improves compensation for healthier members and uses prescription drug data as another way to account for sicker members, according to CMS.
The aim is to improve the consumer experience and strengthen the individual and small group markets as a whole.
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The policies will give consumers additional tools for assessing and comparing plan networks, broaden the availability of this year's new standardized plan options by accommodating state cost-sharing rules, and create protections for consumers enrolling through the direct enrollment channel.
The notice of benefit and payment parameters final rule and the final annual letter to issuers for 2018 focuses on risk stabilization.
Both complement other recent announcements to improve the risk pool, such as actions to address third party payments of premiums and improvements to program integrity for special enrollment periods.
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"The improvements announced today build upon years of work to implement a marketplace that is capable of providing high quality, affordable coverage to all Americans no matter their health status, their income, or where they live" said CMS Acting Administrator Andy Slavitt. "The administration will leave the marketplace on a stable path that, when fully implemented, will ensure quality coverage is available for all Americans well into the future."
CMS also released on Friday the final CMS list of essential community providers for 2018, issuer guidance on uniform rate review timeline, final actuarial value calculator for 2018 and guidance regarding age curves and state reporting.
Twitter: @SusanJMorse