Risk Adjustment (RA) FAQ
Guidance for FAQ regarding Risk Adjustment Operations and Risk Scores
Program Area: Risk Adjustment (RA)
Question: Will Risk Adjustment (RA) risk score calculations include a newborn infant if they are the fourth child and not part of the three (3) oldest children identified in the Patient Protection Affordable Care Act (PPACA) family rating?
Answer: The newborn will have an individual risk score. That risk score will be used in determining the Plan Liability Average Risk Score (PLRS). However, when calculating PLRS, risk scores are weighted by billable member months. The infant's member months will not be counted towards the total billable member months of that plan.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 17, 2019
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