Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: September 17, 2018

Program Area: Risk Adjustment (RA)

Question: In a state market risk pool with only one (1) issuer, does that issuer participate in the Risk Adjustment (RA) program high-cost risk pool and is that issuer subject to the RA user fee for the 2018 Benefit Year and beyond?

Answer: Yes. All issuers of RA covered plans will be charged the annual RA user fee. RA covered plans in a state market risk pool with only one issuer will participate in the high-cost risk pool adjustment beginning for the 2018 Benefit Year. For the purposes of implementing the high-cost risk pool adjustment beginning with the 2018 Benefit Year, the Department of Health and Human Services (HHS) will assess a charge on all issuers of RA covered plans equal to a percent of premium, which will fund high-cost risk pool payments for the portion of claims costs above a certain threshold, and that threshold is established in rulemaking .

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