Risk Adjustment (RA) FAQ
Guidance for FAQ regarding Risk Adjustment Operations and Policy
Program Area: Risk Adjustment (RA)
Question: What is the significance of assigning an age band category?
Answer: In order to perform the necessary RA calculations, all enrollees must be divided into three (3) age categories. The division into these categories is important in determining the algorithm that CMS will need to use to calculate RA risk scores. Each age band (adult, infant, and child) has a different method for calculating risk scores. Enrollees are divided into these age bands by the age at the end of an enrollment period. For additional information, please refer to the RA Do It Yourself (DIY) Software (9/25/18) document, located under the RA program area at https://www.regtap.info/reg_librarye.php?i=2665 in the REGTAP Library.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: January 22, 2019
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