Prepare for and Respond to the Complex World of Risk Adjustment and MLR-based Reporting and Rebates
The ACA included several new financial mechanisms including risk adjustment and MLR-based reporting and rebates to stabilize the insurance market and to further its policy objectives.
The rules that govern these financial requirements have not yet fully been tested and they could have significant impacts on insurers.
Scrutiny and potential enforcement is likely now that the requirements have been in place for several years.
Members of Freeborn’s Healthcare Practice Group can support those who will be most affected by these challenges by helping them address a range of questions:
- Regulatory Inquiries: How do we respond most appropriately to regulators’ requests for information? What data and support will best relieve regulators’ concerns and avoid unwanted consequences?
- Defense of Decision Making and Performance: What evidence and arguments will help us defend our methodology, rates, risk profiles, and overall financial performance to prevent adverse regulatory action?
- Strategies for Advocacy: What path forward protects our interests and avoids unfavorable precedent-setting decisions? What opportunities are presented by these challenges? How do we balance legal risks, business needs, and the expectations of numerous stakeholders? How do we respond in the event of an adverse outcome?
- Internal Communications: How do we best communicate the risks we face to others in our business? How do we present the possible threats to the business in a realistic light and sustain support for our decisions?
Freeborn’s healthcare attorneys have unique experience in advising business clients making decisions that underlie ACA-compliant plans, and they can bring their experience to bear in support of clients facing these complex challenges.