Molina Healthcare Announces Support for HHS’ Efforts to Improve the Marketplace Benefit and Payment Parameters
September 07 2016 - 5:51PM
Business Wire
Molina Healthcare, Inc. (NYSE: MOH) today announced support of
the U.S. Department of Health and Human Services’ (HHS) recently
released Notice of Benefit and Payment Parameters, which seeks to
improve the risk adjustment program by providing policy and
technical guidance related to the Affordable Care Act
Marketplace.
The goal of the HHS risk adjustment program is to compensate
health insurance plans for differences in enrollee health mix so
that plan premiums reflect differences in scope of coverage and
other plan factors, but not differences in health status. This
allows fairer competition in the market and equalizes risk so that
health plans can focus on competing on benefit design, quality
efficiency and value rather than solely on price.
“We welcome the opportunity to work closely with HHS to ensure
the risk adjustment program is as accurate and equitable as
possible,” said J. Mario Molina, MD, President and CEO of Molina
Healthcare. “We encourage HHS to make these and other improvements
sooner rather than later to ensure a viable marketplace for the
future, and we look forward to seeing the positive outcomes that
will result from these actions.”
The proposed rule by HHS introduces several significant changes
to make the risk adjustment program more effective at pooling
risks. One recommendation is to incorporate prescription drugs in
the risk adjustment model, which would lead to a more comprehensive
picture of the severity of an illness and fill in gaps where
diagnoses data may be missing from medical claims. Another change
would be the consideration of better estimate techniques. These
techniques would more accurately reflect the predicted risk of
low-cost enrollees, which are under-accounted for in the current
model. Lastly, the removal of administrative and other non-medical
related costs from the risk transfer formula would eliminate the
transfer of risk adjustment dollars that are unrelated to
enrollee’s health.
Molina currently serves nearly 600,000 Marketplace members
across nine states in which the company already offers other
government-sponsored programs, such as Medicaid and Medicare. These
states include California, Florida, Michigan, New Mexico, Ohio,
Texas, Utah, Washington and Wisconsin.
About Molina Healthcare, Inc.
Molina Healthcare, Inc., a FORTUNE 500 company, provides managed
health care services under the Medicaid and Medicare programs and
through the state insurance marketplaces. Through our locally
operated health plans in 12 states across the nation and in the
Commonwealth of Puerto Rico, Molina serves approximately 4.3
million members. Dr. C. David Molina founded our company in
1980 as a provider organization serving low-income families in
Southern California. Today, we continue his mission of providing
high quality and cost-effective health care to those who need it
most. For more information about Molina Healthcare, please visit
our website at molinahealthcare.com.
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Molina Healthcare, Inc.Investor Relations:Juan José Orellana,
562-435-3666orPublic Relations:Sunny Yu, 562-477-1608
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