Medicare Program; Release of Data Underlying Risk Adjustment Data Validation Provisions

• Published date: 06 March 2019
• Citation: 84 FR 8069
• Record Number: 2019-04052
• Section: Proposed rules
• Court: Centers For Medicare & Medicaid Services

Federal Register, Volume 84 Issue 44 (Wednesday, March 6, 2019)

[Federal Register Volume 84, Number 44 (Wednesday, March 6, 2019)]
                [Proposed Rules]
                [Pages 8069-8070]
                From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
                [FR Doc No: 2019-04052]
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                DEPARTMENT OF HEALTH AND HUMAN SERVICES
                Centers for Medicare & Medicaid Services
                42 CFR Part 422
                [CMS-4185-N2]
                Medicare Program; Release of Data Underlying Risk Adjustment Data
                Validation Provisions
                AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
                ACTION: Proposed rule; supplement.
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                SUMMARY: This document announces the release of data underlying the
                proposed policies regarding the use of extrapolation in Medicare
                Advantage (MA) Risk Adjustment Data Validation (RADV) audits and the
                Fee-for-Service (FFS) Adjuster.
                [[Page 8070]]
                DATES: The data announced in this supplement is available on March 1,
                2019.
                ADDRESSES: The LDS DUA request forms and instructions are available via
                the CMS website at https://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/LimitedDataSets/. Additional documentation and
                data related to the RADV FFS Adjuster Study is posted on the Private
                Plans Team website at https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-Risk-Adjustment-Data-Validation-Program/Resources.html.
                FOR FURTHER INFORMATION CONTACT: Jonathan Smith, (410) 786-4671 or
                Joanne Davis, (410) 786-5127.
                SUPPLEMENTARY INFORMATION:
                I. Background
                 In the November 1, 2018 Federal Register (83 FR 54982), we
                published a proposed rule titled ``Medicare and Medicaid Programs;
                Policy and Technical Changes to the Medicare Advantage (MA), Medicare
                Prescription Drug Benefit, Program of All-Inclusive Care for the
                Elderly (PACE), Medicaid Fee-For-Service, and Medicaid Managed Care
                Programs for Years 2020 and 2021''. The proposed rule included preamble
                language and regulatory provisions regarding the proposed MA Risk
                Adjustment Data Validation (RADV) audit methodology, and the proposal
                not to apply a Fee-For-Service (FFS) Adjuster (83 FR 55037 through
                55041 and 55077). Prior to the release of the proposed rule, we posted
                a FFS Adjuster Study on October 26, 2018.
                 In the December 27, 2018 Federal Register (83 FR 66661), we
                published a document stating that we planned on releasing data
                underlying the FFS Adjuster Study and extending the comment period for
                the RADV provisions to April 30, 2019, in order to maximize the
                opportunity for the public to provide meaningful input to CMS.
                II. Provisions of the Supplement
                 This document announces that data, underlying our proposal not to
                apply a RADV FFS Adjuster, is available to the public through the
                Office of Enterprise Data Analytics (OEDA). Persons or entities
                requesting the data must complete and submit a Limited Data Set (LDS)
                Data Use Agreement (DUA) along with the required fee to CMS. The LDS
                DUA request forms and instructions are available via the CMS website at
                https://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/LimitedDataSets/. Lastly, additional documentation and data
                related to the RADV FFS Adjuster Study is posted on the Private Plans
                Team website at https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-Risk-Adjustment-Data-Validation-Program/Resources.html.
                 We are releasing these data so the public can both provide
                meaningful comments regarding the proposed RADV provisions in the
                November 2018 proposed rule (83 FR 55037 through 55041 and 55077) and
                generate information that will be useful to the agency's decision
                makers. Our ability to meaningfully evaluate and respond to comments
                may depend on the extent to which commenters disclose any
                methodologies, statistical analyses, audit findings, and other factors
                underlying the comments.
                III. Collection of Information Requirements
                 This document does not impose information collection requirements,
                that is, reporting, recordkeeping or third-party disclosure
                requirements. Consequently, there is no need for review by the Office
                of Management and Budget under the authority of the Paperwork Reduction
                Act of 1995 (44 U.S.C. 3501 et seq.).
                 Dated: February 28, 2019.
                Seema Verma,
                Administrator, Centers for Medicare & Medicaid Services.
                [FR Doc. 2019-04052 Filed 3-4-19; 11:15 am]
                 BILLING CODE 4120-01-P