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New Proposed Rule On Risk Adjustment Data Validation
Health Affairs June 1, 2020
On May 29, 2020, the Department of Health and Human Services (HHS) released a proposed rule and press release to adjust the Affordable Care Act’s (ACA’s) risk adjustment data validation (RADV) program. HHS proposes two sets of changes, all of which were discussed in a December 2019 white paper on potential RADV changes.
First, HHS proposes three changes to its methodology for error rate calculations. These changes, if finalized, would begin with the 2019 benefit year for RADV. Second, HHS would change the way that it applies the RADV results to risk adjustment transfers. Currently, RADV results from one year are used to adjust transfers for the following year (i.e., RADV results from the 2017 benefit year affected the risk...
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