CMS releases proposed rule to amend Risk Adjustment Data Validation program

Jun 01, 2020 - 03:50 PM
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The Centers for Medicare & Medicaid Services Friday issued a proposed rule amending the Department of Health and Human Services’ Risk Adjustment Data Validation (HHS-RADV) program.

The proposed rule would amend the error rate methodology and apply the results of the audit to current year rather than subsequent year risk scores. The program validates the accuracy of data that issuers submit to the HHS-operated risk adjustment program to calculate the amount of funds transferred among insurers to adjust for risk based on the individuals they enroll.

According to HHS, the proposed rule addresses stakeholder feedback, and will provide states and issuers with a more stable and predictable regulatory framework, promote program integrity, and foster increased competition. 

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