CMS Gives EDPS Transition Some Breathing Room

CMS published the final call letter for 2018 yesterday, April 3, which included a welcome accouncement regarding the transition from RAPS to EDPS-based RAF scores.  Citing numerous public comments on the subject, CMS throttled back the speed with which they plan to switch over to an encounter-based methodology.  Instead of the blended rates originally contemplated, they announced that the more modest blend of 85% RAPS to 15% EDPS would be used in 2018, allowing more time to improve the reliability of the encounter data methods.  While the RISE data collaboration study was not cited, we believe that the educational value of our study, along with our communication and advocacy of a more moderate approach by CMS, contributed to the confidence with which plans and other interested parties spoke up during the open comment period.  Once again, we owe thanks to the folks at Avalere and Inovalon, as well as at AHIP, for the collegial and professional collaboration.  Also, we want to thank the health plans that actively participated in our study for making this work possible. 


Categories: Risk Adjustment
Tags: RAPS, EDS, EDPS, RAF score, CMS payment, Medicare Advantage

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