Caution: Risk Adjustment Hurdles Facing Plans and Providers Under the Affordable Care Act

January 1, 2014 is fast approaching and regulators, payor organizations, providers, and many other interested parties are working to implement, operationalize, and participate in the state-based American Health Benefit Exchanges and Small Business Health Options Program (‘‘SHOP’’) Exchanges (the ‘‘Exchanges’’).

Many aspects of the Exchanges and the related programs created under the Patient Protection and Affordable Care Act (‘‘ACA’’) will present new challenges to the parties involved. In particular, the risk adjustment programs to be implemented in each state will present many challenges for health plans and providers.

Originally published in Health Insurance Report on 7/17/2013.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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