CMS proposes MA risk adjustment changes for CY 2021

Jan 07, 2020 - 01:50 PM
maryland-model

The Centers for Medicare & Medicaid Services yesterday announced proposed changes to the risk adjustment model for Medicare Advantage organizations and certain demonstrations for calendar year 2021. The proposal would continue phasing in changes to the risk adjustment model required between CYs 2019 and 2022 by the 21st Century Cures Act of 2016. For payment year 2021, CMS would calculate 75% of the risk score based on encounter data and 25% of the score based on Risk Adjustment Processing System data. CMS proposes to continue using its 2020 risk adjustment model to calculate the encounter data-based score and its 2017 risk adjustment model to calculate the RAPS-based score. CMS estimates the proposed changes would cost the Medicare Trust Fund a net $565.5 million in 2021. CMS will accept comments on the proposal through March 6. The agency plans to announce additional proposed changes to its MA payment methodologies for CY 2021 by Feb. 6, and its final 2021 payment rates by April 6.

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