Transcription of HHS-Developed Risk Adjustment Model Algorithm “Do It ...
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HHS-Developed Risk Adjustment Model Algorithm “Do It ...
1 HHS-Developed Risk Adjustment Model Algorithm Do It Yourself (DIY) Software Instructions for the 2021 Benefit Year August 3, 2021 Update1 Section 1343 of the Patient Protection and Affordable Care Act (ACA) provides for a permanent risk Adjustment program. To protect against potential effects of adverse selection and help stabilize premiums in the individual and small group markets, the risk Adjustment program transfers funds from plans with relatively low-risk enrollees to plans with relatively high-risk enrollees. It generally applies to non-grandfathered individual and small group plans inside and outside Exchanges. The HHS risk Adjustment methodology is described in the HHS Notice of Benefit and Payment Parameters for 2014 final rule (78 FR 15410), which was published in the Federal Register on March 11, 2013. The HHS risk Adjustment methodology for the 2021 benefit year is described in the HHS Notice of Benefit and Payment Parameters for 2021 final rule (85 FR 29164) (2021 Payment Notice final rule), which was published in the Federal Register on May 14, The 2021 benefit year implements a new Version 07 (V07) HHS-HCC classification.
changes and internal review and analysis, HHS finalized the V07 HHS-HCC classification with certain modifications from Version 06b in the 2021 Payment Notice final rule. A draft V07 ICD-10 to HHS-HCC Crosswalk for benefit year 2021 was posted May 12, 2020, 5. and the final V07 classification changes were presented in the 2021 Payment Notice ...
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