Maine's Community Health Options insurance cooperative announced last week that it would cease writing new individual health insurance policies on December 15, or December 26 for policies it offers through the Healthcare.gov website. This announcement has increased concerns regarding the solvency of other state cooperatives established under the Consumer Operated and Oriented Plan (CO-OP) Program of the Affordable Care Act (ACA) because the Maine co-op was the only state co-op that had reported profits for 2014. On its website, Community Health Options blamed the partial shutdown on "significant enrollment growth over the last two years and higher than expected claims costs in 2015." The company will, however, continue to offer group policies.
Prior to the Maine announcement, 12 of the 23 state co-ops established under the ACA's CO-OP Program had ceased writing insurance and/or entered insolvency proceedings. One of the key causes of stress on the co-op system is that the co-ops were expecting to receive a variety of payments from the federal government to compensate them for taking on an unusually risky subscriber population. A key component of that compensation is referred to as "risk corridor" payments. The ACA directed the U.S. Department of Health and Human Services to establish a temporary risk corridors program for the years 2014 through 2016, which the Centers for Medicare & Medicaid Services stated was designed to protect "against inaccurate rate-setting by sharing risk (gains and losses) on allowable costs between HHS and qualified health plans to help ensure stable health insurance premiums." Essentially, the federal government intended to reimburse certain costs in excess of a mandated threshold. To date, however, the government has funded only about 12 percent of risk corridor payments through collections from other carriers. Unfortunately, the co-ops only learned of this shortfall very late in the day.
Community Health Options had about $24 million in statutory capital and surplus and over $100 million in assets as of September 30. Although it had recorded a statutory profit of $7.3 million for 2014 and was the only ACA co-op in the black for that year, it lost more than $17 million in the first nine months of 2015 on about $244 million of premiums, even though it was still cash flow positive. Statements by Maine's insurance regulator suggested that worse-than-expected claim experience put the co-op into trouble. He also indicated that the shortfall in risk corridor payments, although not helpful, was not the driving force behind the move to stop new individual business. The full effect of the shortfall in risk corridor payments on Community Health Options will not be known until the co-op files its statutory financial statement in March 2016. If the company's March financials show severe stress, Maine's insurance regulator could potentially place the company into state receivership proceedings (insurance companies are not permitted to file bankruptcy).Given the poor financial condition of the other 10 remaining ACA co-ops, all of which reported losses for 2014 and eight of which have reported losses so far for 2015, the shortfall in risk corridor payments could be a serious blow to their solvency. Day Pitney clients that are creditors of these state co-op insurance plans may want to contact us for assistance in understanding the risks that may lie ahead for these plans and their creditors.
Susan Huntington served as a primary author of "Issues and Considerations in an Evolving Liability Environment: Summaries and Checklists Regarding Protections for Board of Directors and Executive Officers," a toolkit published by the American Health Lawyers Association's (AHLA) Business Law and Governance Practice Group.
On September 20, Susan Huntington presented during an educational call-in discussion, "Insurance and Coverage Risk Management Approaches to Address the Opioid Crisis," for the American Health Lawyers Association (AHLA).
Day Pitney was a presenting sponsor of the 14th Annual Women of Innovation Awards gala, presented by the Connecticut Technology Council and held at the Aqua Turf Club in Southington, CT.
Erin Magennis Healy, Lori J. Braender and Thomas A. Zalewski authored an article, "A Provider's Guide to Managing a Medical Device Recall," which was published in the American Health Lawyers Association Journal of Health & Life Sciences Law.
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Day Pitney's recently updated HIPAA self-assessment tool was featured in an article published in Clinical Lab Products magazine.
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Susan Huntington and Eric Fader were quoted in an article, "Growing HIPAA Focus Leads To Fresh Compliance Options," published in Law360.
Day Pitney LLP is pleased to announce the availability of its updated HIPAA Self-Assessment Tool 2.0 ("Tool"), designed to provide an easy and cost-effective way for organizations to perform a self-assessment of HIPAA compliance based on the U.S. Department of Health and Human Services' Office for Civil Rights ("OCR") expanded audit protocol.