CMS ends risk-adjustment freeze, releasing $10.4B to insurers

The final rule (PDF), released by the Centers for Medicare & Medicaid Services (CMS) on maintains the same methodology for risk-adjustment transfers previously outlined by the agency, using statewide average premiums as part of the formula. CMS included an additional explanation in the rule on the formula.  For the 2018 and 2019 benefit years, CMS will adjust statewide average premiums by 14% to account for an estimated proportion of administrative costs that do not vary with claims.

Source: https://www.fiercehealthcare.com/payer/cms-risk-adjustment-final-rule-methodology-aca