AMGA submitted comments to the Centers for Medicare and Medicaid Services (CMS) on its discussion paper concerning proposals to modify the risk adjustment methodology for individual and small group health insurance plans offered on state health insurance marketplaces that were created under the Affordable Care Act (ACA). In comments to CMS, AMGA supported the idea of factoring partial year enrollees, who may have higher healthcare costs, into the risk adjustment methodology. AMGA also recommended that CMS consider socioeconomic and sociodemographic factors as part of its efforts to improve risk adjustment for plans offered on the ACA marketplaces.
“Research indicates there is a relationship between socioeconomic status, race and ethnicity, and healthcare status and outcomes,” said Donald W. Fisher, Ph.D., CAE, AMGA’s president and chief executive officer. “To accurately account for the health mix of plan enrollees, these factors should be part of a risk adjustment methodology.”
AMGA also agreed with CMS that patient prescription drug use and high-cost enrollees are appropriate factors to consider when revising the risk adjustment methodology.
Read AMGA’s comments.
