Favorable New Mexico Health Connections ruling has national implications
A federal judge in New Mexico has ruled in favor of New Mexico Health Connections in a case that raises questions about billions of dollars in payments that have been made nationally to a federal program under the Affordable Care Act.
Health Connections filed a lawsuit in 2016 arguing, among other things, that the federal government's risk adjustment program — which redistributes money from insurers with healthier customers to those with sicker customers — relied on a flawed formula to determine how the money was disbursed.
U.S. District Judge James O. Browning agreed with Health Connections on that point and said the methodology used by the federal Health and Human Services department was "arbitrary and capricious."
The court ruled that the way the formula used statewide average premiums to calculate charges and payments in the program had not been adequately rationalized by the department. It rejected several other claims made by Health Connections.
Read more: http://www.lcsun-news.com/story/news/local/new-mexico/2018/03/02/favorable-nm-health-connections-ruling-has-national-implications/390119002/