Washington, D.C. (January 30, 2023) – The Alliance of Community Health Plans (ACHP) is disappointed by policies included in the Centers for Medicare and Medicaid Services (CMS) final risk adjustment data validation (RADV) rule. ACHP has long believed that this rule is flawed and has repeatedly called on the Administration to reopen the rule for comment to meaningfully address program integrity in MA.
“This rule comes with enormous costs and fails to target the most egregious diagnosis coding violations,” said ACHP President and CEO Ceci Connolly. “We believe that our members submit accurate risk adjustments for beneficiaries and are upfront in correcting errors when found. We are disappointed by the final regulation and hope CMS reconsiders more targeted approaches to meaningfully address compliance in the MA program and protect the taxpayer dollar.”
ACHP is concerned about the resources required of nonprofit regional health plans, which operate on small margins, in carrying out the requirements of the final rule, as well as the impact it will have on care for MA beneficiaries across the country. MA is the choice of America’s seniors, with over 30 million beneficiaries and growing. MA plans have fewer payment errors than traditional fee-for-service Medicare and are committed to meeting high standards of accountability in compliance with MA program requirements. These changes to the RADV audit process could disrupt care for enrollees and do not appropriately address program integrity.
The Alliance of Community Health Plans (ACHP) represents the nation’s top-performing nonprofit health companies, which serve tens of millions of Americans in 37 states and D.C. ACHP member plans collaborate with providers on high-quality coverage and care — leading the industry in practical reforms.
ACHP is the voice of a unique payer-provider partnership model advancing proven solutions that deliver better value for patients, employers and taxpayers. Contact us for case studies and data about member innovations and results.
New from ACHP:
- ACHP Letter to Congress on MA Broker Payments
- PBMs are Clear as Mud: The Value of a Fee-Based, Transparent Model
- ACHP Letter to CMS on Broker Payment Reform
- ACHP’s MA for Tomorrow FAQ Sheet
- ACHP Letter to CMS on Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems
- ACHP Letter to CMS on Short-Term, Limited-Duration Insurance Plans