CMS finalizes rule amending risk adjustment data validation program

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CMS finalizes rule amending risk adjustment data validation program
tjordan_drupal
Nov 25, 2020

The Centers for Medicare & Medicaid Services yesterday issued a final rule amending the Department of Health and Human Services’ Risk Adjustment Data Validation program, which validates the data that health insurers submit to HHS to determine risk adjustments based on the individuals they enroll. The rule amends the program’s error rate methodology and applies the results of the HHS audit to risk scores for the current rather than the subsequent year. CMS said the 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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CMS finalizes rule amending risk adjustment data validation program
tjordan_drupal
Nov 25, 2020

The Centers for Medicare & Medicaid Services yesterday issued a final rule amending the Department of Health and Human Services’ Risk Adjustment Data Validation program, which validates the data that health insurers submit to HHS to determine risk adjustments based on the individuals they enroll. The rule amends the program’s error rate methodology and applies the results of the HHS audit to risk scores for the current rather than the subsequent year. CMS said the 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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