Risk Corridors (RC) FAQ
Guidance for FAQ regarding Data Submission and Enrollment Count for Transitional Policy
Program Area: Risk Corridors (RC)
Question: Can the Centers for Medicare & Medicaid Services (CMS) confirm that the enrollment range of a small group should be between one (1) and 100 for Risk Corridors enrollment?
Answer: The Risk Corridors program uses the employee counting method determined by state law. The Risk Adjustment program permits issuers to use either a Federal or state employee counting method, provided that the method accounts for part-time employees. The Medical Loss Ratio (MLR) program uses a Federal counting method. Because this could result in a discrepancy in the definition of market between the MLR and Risk Corridors programs, CMS intends to modify the MLR Annual Reporting Form to accommodate this difference. CMS expects to publish the proposed version of the Risk Corridors plan-level data collection form and the Annual MLR Reporting Form (modified to include collection of Risk Corridors data) in the Federal Register on January 30, 2015. The forms will be open for public comment for 60 days following publication.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 02, 2015
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