CMS offers plans a variety of resources on the RADV program. Check back as content and links will be added to this page periodically.
The Centers for Medicare & Medicaid Services (CMS) has requested a 120-day extension for public comments for the RADV provision in the Notice of Proposed Rulemaking (NPRM) 2020 MA/Part D rule that was published in the Federal Register on November 1, 2018. CMS will further extend the public comment period until August 28, 2019, for NPRM: Medicare and Medicaid Programs; Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Program of All-Inclusive Care for the Elderly, Medicaid Fee-For-Service, and Medicaid Managed Care Programs for Years 2020 and 2021 (CMS-4185-P).
Additionally, CMS plans to release data underlying a Fee-for-Service Adjuster Study posted on the CMS website on October 26, 2018, which is addressed in the NPRM. CMS is extending the comment period for the RADV provision to give the public an opportunity to submit meaningful comments to the RADV provision proposal.
NPRM 4185-P RADV Data Dictionary and NPRM 4185-Provisional Fee for Service Adjuster Coefficients workbook is now publically available in the downloads section. We are planning to post additional information shortly. Accordingly, we recommend that you check back again soon.
NPRM 4185-P RADV Data Release Data File Descriptions
This file lists the risk scores based on the normalized coefficients for each ELIGIBLE MA enrollee in the SAMPTB_Y13_ELIG1M. This risk score was calculated by summing the relative factors that were calculated from the normalized coefficients. The enrollees can be linked back to SAMPTB_Y13_ELIG1M by the identifier field LNKEYNUM.
This file lists the risk scores based on the normalized coefficients for each FULL MA enrollee in the SAMPTB_Y13_FULL1M. This risk score was calculated by summing the relative factors that were calculated from the normalized coefficients. The enrollees can be linked back to SAMPTB_Y13_FULL1M by the identifier field LNKEYNUM.
Data release described in Federal Register notice displayed on June 27th for RADV provision CMS-4185-N4 and referenced on April 30, 2019 (84 FR 18215).
RADV Provision CMS 4185-N4 Data Release June 2019 (ZIP)
NPRM 4185 RADV Data Dictionary (XLSX)
FFS Adjuster Technical Appendix (PDF)
Medical Record Reviewer Guidance March 2019 (PDF)
FFS Adjuster Excecutive Summary (PDF)
RADV Fact Sheet 2013 (PDF)
RADV Checklist (PDF)
RADV Methodology (PDF)
Medical Record Reviewer Guidance January 2020 (PDF)