Final

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

Issue Date: November 14, 2014

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

Question: What types of organizations are required to set-up an EDGE server?

Answer: All issuers in the individual markets offering non-grandfathered, Affordable Care Act (ACA) compliant major medical coverage both on and off of the Marketplaces in a State where the Department of Health and Human Services (HHS) is operating Reinsurance (RI) are required to establish an EDGE server in order to receive RI payments. All issuers in the Individual and Small Group markets offering non-grandfathered, ACA-compliant coverage both on and off of the Marketplace in a State where HHS is operating Risk Adjustment (RA) are required to participate in the RA program. Issuers that only offer transitional plans, grandfathered plans or plans that do not conform with the ACA market reform and coverage rules (e.g., ACA rating requirements, essential health benefits requirements are not eligible to receive RI payments and participate in the RA program).

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