The Centers for Medicare & Medicaid Services (CMS) wants to get more use out of the data Medicare Advantage insurers are sending in for the Medicare Advantage risk-adjustment program.
CMS — the parent of the Center for Consumer Information & Insurance Oversight (CCIIO), the agency that oversees implementation of Patient Protection and Affordable Care Act (PPACA) commercial health insurance market programs — uses the risk-adjustment program to increase subsidies for plans that insure people who appear to be expensive to insure.
PPACA has created a new risk-adjustment for the commercial health insurance market, and CMS administration of the Medicare Advantage risk-adjustment program could be a model for how CCIIO runs the commercial health insurance risk-adjustment program.
CMS already can use the risk-adjustment program data filings to determine the risk-adjustment factors it uses to adjust payments, conduct quality review and improvement activities, and satisfy “Medicare coverage purposes.”
CMS now wants to add several named purposes for using the insurers’ risk-adjustment program data.