Code of Massachusetts Regulations › 956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY › Title 956 CMR 13.00 - Risk Adjustment Procedures For Small And Non-group Market › Section 13.05 - Transfer Calculation and Payment

Current through Register 1525, July 5, 2024
(1) The Connector will annually complete fund
			 transfer calculations according to the Risk Adjustment Methodology established
			 by the Connector for the applicable Benefit Year. The calculations will be
			 based on the data that has been reported to CHIA as of April
			 30th of the year following the applicable Benefit
			 Year.
(2) If a Carrier fails to
			 submit data or submits inaccurate or incomplete data to the MA APCD within the
			 timeframe required, such that the Connector cannot apply the applicable Risk
			 Adjustment Methodology to calculate the risk adjustment payment transfer amount
			 in a timely fashion, the Connector may assess a default risk adjustment charge,
			 calculated according to the methodology established by the Connector for the
			 applicable Benefit Year.
(3) The
			 Connector will issue a Final Risk Adjustment Payments and Charges Report to
			 each Carrier by July 1st of the year following the
			 applicable Benefit Year, reporting on the calculation of risk scores and
			 transfer payments. The report will state the amounts of the risk adjustment
			 charges that must be paid or transfer payments that will be received by the
			 Carrier.
(4) Carriers that are
			 assessed risk adjustment charges must pay the amount specified in the Final
			 Risk Adjustment Payments and Charges Report provided by the Connector within 30
			 calendar days after issuance of the Final Risk Adjustment Payments and Charges
			 Report, in accordance with instructions provided by the Connector.
(5) Risk adjustment charges shall be subject
			 to an interest rate of twelve per cent per annum that will begin to accrue 40
			 calendar days after issuance of the Final Risk Adjustment Payments and Charges
			 Report stating those charges.
(6)
			 Following receipt of charges from Carriers that are assessed charges, the
			 Connector will, from the charges received, make payments to Carriers that are
			 owed risk adjustment payments. Transfer payments will be made after and only to
			 the extent of receipt of risk adjustment charges. To the extent that the
			 Connector has not received full payment of all risk adjustment charges by the
			 due date, the Connector will distribute payments to recipient Carriers on a
			 pro-rated basis, proportional to the total risk adjustment payments due to each
			 Carrier. If, after making the initial payments, the Connector receives
			 additional risk adjustment charges from Carriers making late payments,
			 additional payments will be made to recipient Carriers on a pro-rated basis,
			 proportional to the total risk adjustment payments due to each
			 Carrier.
(7) If a Carrier that is
			 owed a risk adjustment transfer payment for a particular calendar year has at
			 that time an unpaid risk adjustment charge from a prior year, the amount of the
			 transfer payment will be reduced by the amount of the unpaid charge.
(8) A Carrier's compliance with the
			 requirements of the Risk Adjustment Program, including submitting accurate and
			 timely data and making required risk adjustment transfer payments in a timely
			 manner, shall be considered a condition of participation as a qualified health
			 plan offered through the Connector, and a Carrier's failure to comply with
			 these requirements constitutes grounds for the Connector to de-certify that
			 Carrier as a qualified health plan.