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HHS/CMS RIN: 0938-AU23 Publication ID: Spring 2020 
Title: ●Amendments to the HHS-Operated Risk Adjustment Data Validation Under the Patient Protection and Affordable Care Act's HHS-Operated Risk Adjustment Program (CMS-9913) 

This rule would adopt certain technical changes to the risk adjustment data validation error estimation methodology for states where the Department of Health and Human Services (HHS) operates the risk adjustment program.  The Patient Protection and Affordable Care Act (PPACA) established a permanent risk adjustment program under which payments are made to health insurance issuers that attract higher-than-average risk populations funded by payments from health insurance issuers that attract lower-than-average risk populations.  To ensure the integrity of the HHS-operated risk adjustment program, CMS, on behalf of HHS, performs risk adjustment data validation, also known as HHS-RADV, to validate the accuracy of data submitted by issuers for the purposes of risk adjustment transfer calculations. 

Agency: Department of Health and Human Services(HHS)  Priority: Other Significant 
RIN Status: First time published in the Unified Agenda Agenda Stage of Rulemaking: Proposed Rule Stage 
Major: No  Unfunded Mandates: No 
EO 13771 Designation: Other 
CFR Citation: 45 CFR 153   
Legal Authority: Pub. L. 111-148, secs. 1321 and 1343   
Legal Deadline:  None
Action Date FR Cite
NPRM  06/00/2020 
Regulatory Flexibility Analysis Required: No  Government Levels Affected: None 
Federalism: No 
Included in the Regulatory Plan: No 
RIN Data Printed in the FR: No 
Agency Contact:
Allison Yadsko
Health Insurance Specialist
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Consumer Information and Insurance Oversight, MS: WB-24-40, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-1740