Risk Adjustment (RA) FAQ
Guidance for FAQ regarding Risk Adjustment Operations and Policy
Program Area: Risk Adjustment (RA)
Question: Can the Centers for Medicare & Medicaid Services (CMS) elaborate on which plans are not included in the Risk Adjustment (RA) calculations?
Answer: Any grandfathered or non-Patient Protection Affordable Care Act (PPACA) compliant plans, dental plans or student health plans are not included in RA calculations. In addition, any plans that do not provide RA data for their enrolled members, or submit inadequate RA data will not be included in RA calculations, and will, therefore, be assessed a default charge.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 17, 2019
HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.