View Rule

This final rule sets forth the rationale for selecting the statewide average premium as the cost-scaling parameter in the risk adjustment methodology that HHS uses when operating the permanent risk adjustment program established in section 1343 of the Patient Protection and Affordable Care Act on behalf of a state for the 2018 benefit year. The HHS-operated risk adjustment methodology includes the payment transfer formula which utilizes the statewide average premium to achieve budget neutrality. This aspect of the HHS-operated risk adjustment methodology was vacated by the decision of the United States District Court for the District of New Mexico as to its use for the 2014 through 2018 benefit years.