1. UPDATE HHS-Operated Risk Adjustment Methodology Meeting March 31, 2016
OPI Update
UPDATE
HHS-Operated Risk Adjustment Methodology Meeting
March 31, 2016
9:00 a.m. – 4:30 p.m. ET
CMS Headquarters, Baltimore, MD
CMS will hold a public conference to discuss potential improvements to the HHS Risk Adjustment methodology for the 2018 benefit year and beyond.
Send all correspondence to:
REGISTRATION NOW OPEN!

2. What is CMS015 Risk Adjustment?
Transfers funds from high-risk plans to low-risk plans
Applies generally nationwide
Why is CMS holding an Onsite?
To solicit feedback on possible changes to the Risk Adjustment calculation methodology
Each enrollee gets a risk score based on medical claims submitted to the DDC EDGE server
Current calculations do not include pharmacy claims or historical diagnoses

3. Who at ARDX participates in preparing for the RA Onsite impact work at ARDX?
Implementation Consultant (Theo) and OPI Director (Dot)- Project management and client communication
Registrars and CXM: Event logistics, registration, remote access coordination, branding templates, transcription
Content Team (OPI CMS015 RA Team): Slide development, quality control, post-session deliverables
DRE: Collecting feedback and conducting
evaluations

4. Looking Ahead: 2016 OPI Milestones
Jan
Feb
Mar
Apr
May
Jun – Jul
Aug – Sep
Oct – Nov
Dec
2015 Data Collection Deadline
RA Calculations
Issuer Appeals
HRADV IVA
HIX8 820 Transaction Issued
RI Payment Report
RI Interim Payments
CSR Reconciled Amounts Issued
EDGE Server Maintenance Release
Final Discrepancy Reporting
RA Payment Report
HIX 820 Transactions Issued: Monthly beginning 1/29/16 – 1/30/16
EDGE Server Maintenance Release: 2/26/16
RA Calculations: 1/9/2016 – 5/3/2016
RI Interim Payments Issued: 3/14/16 – 3/18/16
2015 Benefit Year (BY) Data Submission Deadline: 5/2/2016
Final Discrepancy Reporting Period: 5/3/2016 – 5/20/2016
Final RI/RA Payment Reports Issued: 6/30/16
Cost-sharing Reduction (CSR) Reconciled Amounts Issued: 6/30/16
Issuer Appeals: 7/1/2016 – 7/31/2016
HHS-operated Risk Adjustment Data Validation (HRADV) Initial Validation Audit (IVA) : 8/31/2016 – 12/31/2016