Final

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

Issue Date: July 25, 2019

Program Area: Risk Adjustment (RA)

Question: How should I treat the 2017 benefit year Health and Human Services Risk Adjustment Data Validation (HHS-RADV) adjustments to the risk adjustment transfer amounts including default data validation charges (DDVC) and allocations for Medical Loss Ratio (MLR) reporting and rates?

Answer: CMS updated the MLR Form Instructions to clarify that 2018 benefit year MLR reports will only reflect 2018 RA transfer report results (before application of any 2017 HHS-RADV adjustments); 2017 RADV adjustments will be reported in the 2021 MLR reporting year. CMS also updated the 2020 benefit year URRT instructions so that issuers and states have options to account for 2017 benefit year HHS-RADV adjustments in rate setting. For more information on how to report the 2017 benefit year RADV adjustments (including DDVC and DDVC allocation), please review the "HHS Risk Adjustment Data Validation (HHS - RADV): Timing of 2017 Benefit Year HHS - RADV Collections, Payments, and Reporting" located at: https://www.regtap.info/reg _librarye.php?i=2958.

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