he U.S. Department of Health and Human Services (HHS) must reconsider a Formula that affects Billions of Dollars in Affordable Care Act (ACA) Payments to Insurers, a New Mexico Federal Judge said Wednesday.

In an 83-page order, U.S. District Judge James O. Browning Vacated HHS’ Risk Adjustment Formula and sent it back to the Agency for further Review.

Although the Agency’s decision to Base its Calculations on Statewide Average Health Insurance Premiums complied with the ACA, it was still “arbitrary and capricious,” he said.

It was not immediately clear what the Financial Implications of the Ruling were for Health Connections, a Not-for-Profit Health Co-Op established with Affordable Care Act Loans, nor for the other Organizations that have collectively submitted Billions of Dollars in Risk Adjustment Payments since 2014. But the Regulations that were Vacated by the Court applied to every State except Massachusetts for a Two-Year period, which had its own Risk Adjustment Program at the time.









NYC Wins When Everyone Can Vote! Michael H. Drucker