Draft Payment Notice For Free

CMS regulations establish or modify the way CMS administers its programs. CMS' regulations may impact providers or suppliers of services or the individuals enrolled or entitled to benefits under CMS programs.

This work applies to the following Medicare-participating facilities: Ambulatory Surgical Centers (ASCs); Community Mental Health Centers (CMHCs); Comprehensive Outpatient Rehabilitation Facilities (CORFs); End-Stage Renal Disease (ESRD) Facilities; Federally Qualified Health Centers (FQHCs);

The risk adjustment user fee for 2023 is $0.22 per member per month, down slightly from the user fee of $0.25 per member per month from 2022. HHS expects it will cost about $60 million in benefit year 2023 to operate the risk adjustment program, the same as for 2022.

Risk adjustment is used to adjust plan bids, as well as payments to plans based on their enrollee's expected health care costs. The CMS-HCC based Medicare risk adjustment models are prospective: diagnoses in one year are used to predict costs in the following year.

Risk adjustment is a statistical method that seeks to predict a person's likely use and costs of health care services. It's used in Medicare Advantage to adjust the capitated payments the federal government makes to cover expected medical costs of enrollees.

The risk adjustment program transfers funds from lower-risk, non-grandfathered plans in the individual and small group markets to higher-risk, non-grandfathered plans, both in and out of the marketplace.

The Patient Protection and Affordable Care Act established a permanent risk adjustment program (in section 1343), one of three premium stabilization programs, to provide payments to health insurance issuers that cover higher-cost and higher-risk populations to more evenly spread the financial risk borne by issuers and