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

Issue Date: July 25, 2019

Program Area: Risk Adjustment (RA)

Question: Why did CMS reissue benefit year 2017 and benefit year 2018 state payment transfer issuer reports on August 1, 2019?

Answer: CMS reissued risk adjustment transfer reports on August 1, 2019 to include the 2017 benefit year Health and Human Services Risk Adjustment Data Validation (HHS-RADV) results used to adjust benefit year plan liability risk scores and subsequently transfers. The 2017 benefit year HHS-RADV error rates are generally used to adjust 2018 benefit year plan liability risk scores, resulting in adjustments to 2018 benefit year risk adjustment transfer amounts. The one exception to this general rule is for issuers that exited all of the risk pools in the state, whose 2017 benefit year HHS-RADV error rates are used to adjust 2017 benefit year plan liability risk scores, resulting in adjustments to 2017 benefit year risk adjustment transfer amounts.

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