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

Issue Date: May 22, 2020

Program Area: Risk Adjustment (RA)

Question: If an issuer does not have a metal level assigned for any plans, will risk scores for plan enrollees be zero (0)?

Answer: Correct, the risk score calculation requires a plan metal level for the enrollee. The risk adjustment (RA) methodology consists of concurrent RA models, one for each combination of metal level (platinum, gold, silver, bronze and catastrophic) and the age group (adult, child, and infant). For more information on RA models, see the current and prior benefit year Do-It-Yourself (DIY) Software Instructions posted on the Center for Consumer Information and Insurance Oversight (CCIIO) website at: https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/index.html.

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