Barak A. Bassman, a partner in the Health Sciences Department and Antitrust and Trial and Dispute Resolution Practice Groups of Pepper Hamilton, was quoted in the July 20, 2018 Fierce Healthcare article, "New Mexico Health Connections to Appeal Portions of Risk Adjustment Ruling Regardless of Pending Decision."
New Mexico Health Connections, the insurer that challenged the Department of Health and Human Services’ (HHS) risk adjustment formula, plans to appeal portions of the judge’s February decision, lead attorney Barak Bassman with Pepper Hamilton LLP told Fierce Healthcare.
He said the consumer operated and oriented plan (CO-OP) will file its appeal whether or not the district judge upholds his decision to vacate portions of the risk adjustment formula. The Centers for Medicare & Medicaid Services (CMS) has asked the court to reconsider its decision to remand part of the formula that relies on statewide average premiums, but the insurer remains concerned about several other aspects of the program.
“New Mexico Health Connections and others have submitted proposals to fix this bias, but HHS has repeatedly refused to take any action,” Bassman said, adding that the current formula “systematically and materially underestimates the costs of covering enrollees” without a designated chronic condition.
For now, Bassman says the court’s ruling provides a chance for federal officials to fix some of the inherent flaws in the formula.
“This gives a real opening to CMS and the industry to really come up with a better solution and a better path going forward that will help consumers and the ACA,” Bassman said. “That’s our end game. We want to make the ACA work better and want a risk adjustment formula that works right.”