Frequently Asked Question (FAQ)


FAQ ID:  9260 Publish Date: 09/28/2018

Program Area:

Risk Adjustment (RA)

Primary Category:

Risk Adjustment Operations

Secondary Category:

Payments

Question:

How will Risk Adjustment (RA) payments and charges be transferred?

Answer:

The Centers for Medicare & Medicaid Services (CMS) will collect funds from issuers due to remit charges and disburse collected funds to issuers receiving a payment. RA is a budget neutral program that transfers funds from plans with lower risk enrollees to plans with higher risk enrollees in a state market risk pool. Therefore, RA payments and charges within a market and risk pool must net to zero (0) dollars.


*

Send Email