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HHS/CMS RIN: 0938-AU23 Publication ID: Fall 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 adopts certain changes to the risk adjustment data validation error estimation methodology starting with the 2019 benefit year and beyond 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 HHSRADV, 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: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Completed Actions 
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  06/02/2020  85 FR 33595   
NPRM Comment Period End  07/02/2020 
Final Action  12/01/2020  85 FR 76979   
Final Action Effective  12/31/2020 
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