The Centers for Medicare & Medicaid Services (CMS) issued a notice Friday that it couldn’t meet the timeline to finalize the proposed rule originally issued on November 1, 2018.
CMS has again extended the timeline for publication of the Medicare Advantage Risk Adjustment Data Validation (RADV) regulations—this time until February 1, 2023.
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Under the Social Security Act, CMS must publish a Medicare final rule no later than three years after the publication date of the proposed rule. Last year, the agency said it was unable to meet the three-year timeline publication due to “exceptional circumstances” and extended publication to Nov. 1, 2022. However, in an unpublished proposed rule issued Friday, CMS said it needs an additional three months for the same reason. The document is scheduled to be published in the Federal Register on November 1.
The November 1, 2018 proposed rule would revise the agency’s authority to extrapolate in the recovery of RADV overpayments, starting with payment year 2011 contract-level audits and without the use of a fee-for-service (FFS) adjuster to the RADV overpayment determinations.
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In last year’s notice of the one-year extension of the timeline for publication of the final rule, CMS indicated that the delay involved the FFS Adjuster Study, which was published a few days before the RADV proposed rule. CMS extended the comment period for the proposed RADV propositions of the rule until April 2019 with a plan to release data underlying the FFS Adjuster study. Although it had released the data underlying the FFS Adjuster Study in March 2019, CMS later announced an additional extension of the RADV provision until August 2019 as well as additional material related to the FFS Adjuster Study and again sought public comment.
“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.