Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: September 15, 2017

Program Area: Distributed Data Collection (DDC) for RA Including HCRP/EDGE Server

Question: In a state market risk pool with only one (1) issuer, will CMS require the issuer to submit data on the External Data Gathering Environment (EDGE) server for the 2018 Benefit Year and beyond?

Answer: Yes, because the issuer will still participate in the high-cost risk pool. Issuers that are the only issuer in a state market risk pool will be required, at a minimum, to submit premium and enrollment data for RA covered plans in order for CMS to calculate the national high-cost risk pool charge and the RA user fee. Similarly, issuers will be required to submit data to the EDGE server to qualify for high-cost risk pool payments. The percent of premium charge for the high-cost risk pool will be assessed even if issuers that are the only issuer in a state market risk pool choose not to submit EDGE data. However, because these issuers do not have transfers under the RA program against other issuers in the state risk pool, additional data submission to the EDGE server will be optional for these issuers.

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