CMS to pay only 12.6% of claims for 2014 risk corridors program this year

The risk corridors program will pay only 12.6% of 2014 claims requested by insurers, the Centers for Medicare & Medicaid Services announced yesterday. The program collected about $362 million in charges for 2014 and received $2.87 billion in payment requests, so remaining 2014 claims will be paid out of 2015 collections, or if necessary, 2016 collections, the agency said. “In the event of a shortfall for the 2016 program year, [the Department of Health and Human Services] will explore other sources of funding for risk corridors payments, subject to the availability of appropriations,” CMS said. “This includes working with Congress on the necessary funding for outstanding risk corridors payments.” 2014 was the first year of the three-year program, which charges Qualified Health Plans with healthier enrollees in the Health Insurance Marketplace to help offset costs for QHPs with sicker consumers in that state.