“The Centers for Medicare & Medicaid Services (CMS) does not propose that states collect personal data such as name, social security number or address for the risk adjustment program,” wrote Steve Larsen, Director of the Center for Consumer Information and Insurance Oversight in a blog posting.
“Protecting an individual’s personal health information continues to be among CMS’ highest priorities. That is why CMS will not require states to collect your medical record or information that identifies your doctor; nor would the Federal government collect this information.”
Posted Oct. 13 on healthcare.gov, a federal website managed by the U.S. Department of Health and Human Services, Larson discussed the recently released proposed rule wherein CMS laid out general options for collecting information to support risk adjustment, including an intermediate model in which states would collect information such as claims that are currently used for payment purposes.
Work has not begun on this project, clarified Larsen.
The Patient Protection and Affordable Care Act (PPACA) calls for a risk adjustment program that aims to eliminate incentives for health insurance plans to avoid people with pre-existing conditions or those who are in poor health, according to Larsen. “Risk adjustment ensures that health insurance plans have additional money to provide services to the people who need them most by providing more funds to plans that provide care to people that are likely to have high health costs. Insurance plans then compete on the basis of quality and service, and not on the basis of whether they can attract healthy people.”
Health insurance programs that currently use risk adjustment—including Medicare and many state Medicaid programs—collect certain information about enrollees’ medical conditions so that they can estimate the potential that any given health plan will incur high costs, Larsen wrote adding that this information is necessary for a successful risk adjustment program.
Larsen concluded that comments on risk adjustment are welcome and should be submitted here.