News: RADV rule publication postponed three more months by CMS

The timeline for publication of the Medicare Advantage Risk Adjustment Data Validation (RADV) regulations has been extended further until February 1, 2023, according to a recent notice issued by CMS. The three-year deadline under the Social Security Act for a Medicare final rule has been up since November 1, 2022, but was extended a year due to exceptional circumstances. Now CMS has stated it needs another three months for the same reason, Rise Health reported.

The agency’s authority to extrapolate in the recovery of RADV overpayments would be revised with the proposed rule, first proposed back in 2018. During the one-year extension, CMS cited a fee-for-service (FFS) adjuster study published just before the RADV proposed rule as a main component in the delay. The agency released data underlying the study in March 2019, and again sought public comment in August of that year while publishing additional material related to the study.

“We continue to have ongoing delays resulting from the agency’s focus on the COVID-19 public health emergency, and we have determined that additional time continues to be needed to address the complex policy and operational issues that were raised,” CMS said in the most recent notice.

Given that the agency’s authority to extrapolate in RADV overpayment recovery would start with payment year 2011 contract-level audits and would be without the use of a FFS adjuster to the RADV overpayment determinations in the 2018 proposed rule, the regulations published by February 1, 2023 may have a large impact on Medicare Advantage plans.

Editor’s note: To read Rise Health’s coverage of this story, click here. To access CMS’s issued notice, click here.