News Briefs: CMS Extended Plans to Issue a Final Rule on Extrapolation in RADV Audits

CMS is buying itself more time to make a final determination about its use of extrapolation in Risk Adjustment Data Validation (RADV) audits. In a Federal Register notice, the agency pushed its Nov. 1 deadline to issue a final RADV rule to Feb. 1, 2023, saying it was unable to meet the already extended deadline “because of ongoing exceptional circumstances.” The Trump administration in a November 2018 proposed rule (83 Fed. Reg. 54982, Nov. 1, 2018) said its plans to recoup improper payments starting with payment year 2020 would not involve a “fee-for-service adjuster” and that it may apply this extrapolation methodology when finalizing audits dating back to payment year 2011. That rule received pushback from insurers for its potential to inflate audit recoveries, skew the MA bidding process and impact beneficiary cost-sharing and MA product offerings. The provision was not finalized by the Trump administration. CMS in October 2021 extended the statutory three-year timeline for completing the rulemaking, explaining that it received extensive public comments on the proposal and the FFS adjuster study that it released just prior to publishing the November 2018 proposed rule.

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