Resources
SQL Risk Adjustment Model
DIY HHS-HCC Model: Plan Years 2021-2025
CMS publishes DIY SAS Risk Adjustment code for the HHS-HCC model used in commercial (ACA) Risk Adjustment. This model is useful for tracking risk scores across time and validating data submitted to the EDGE server. However, the model is not typically published till the middle of the current plan year (i.e. the 2024 DIY model will be published in July or August of 2024). Additionally, many health plans may not have the licensing or expertise to deploy SAS. To help support health plans, researchers, vendors, and other risk adjustment enthusiasts, we developed a SQL-based DIY model that we offer for free, using the SAS code as the starting point and then supplementing with the coefficients published in the NBPP for 2024 and 2025.
Useful Links
Charles Gaba is an independent analyst who provides commentary and analysis about the ACA markets and health care policy.
David Anderson - Balloon Juice
David Anderson is a Duke University doctoral student and a researcher at Duke’s Margolis Center for Health Policy who formerly worked for the UPMC health plan during the implementation of the ACA. His blog posts at Balloon Juice provide insightful commentary on a variety of health policy topics.
CMS - Premium Stabilization Programs
CMS publishes reports on Risk Adjustment and RADV at this site, notably the reports on risk adjustment and RADV transfers/adjustments at the issuer and state level. The documents here provide useful context on trends and changes in the ACA markets.
CMS - CCIIO Regulations and Guidance
CMS publishes regulations and guidance for commercial health plans here. Resources published here include the SAS DIY risk adjustment model, information on the No Surprises Act, MLR filing instructions, and much more.
CMS's Registration for Technical Assistance Portal (REGTAP) is a login-required site where detailed information on ACA Marketplace operations is published. Information such as EDGE Server documentation, FFM enrollment operational information, and rate filing guidance is published on REGTAP.
We maintain our list of sites and resources that can provide useful information on the ACA markets.
If you think something is missing, let us know by sending us an email.
Notice of Benefit and Payment and Parameters 2025
Analysis and Summary
Coming soon…. In the meantime, we’ve compared the 2024 risk adjustment coefficients to the 2025 coefficients (silver plan) to give you a quick overview of how the RA model is changing…
Notice of Benefit and Payment Parameters 2024
Analysis and Summary
On December 12, 2022, the Department of Health and Human Services released the proposed Notice of Benefits and Payment Parameters for 2024, which contains regulations and guidance for plans sold through the Affordable Care Act (ACA) marketplaces. This policy brief is a summary analysis of the regulations, focused on their impact on carriers who participate (or plan to participate) in the ACA market.
APTC Audit Analysis
PY 2018 and 2019
CMS Recently released audit reports of issuers who offered Qualified Health Plans and/or Standalone Dental Plans in the Federally-Facilitated Marketplace (FFM) from plan years 2018 and 2019. These reports showed that carriers of all sizes face operational challenges in managing their receipt of Advanced Premium Tax Credits; this report from Evensun summarizes the results of these audits and provides some recommendations for issuers in maximizing their APTC payments and remaining compliant with CMS regulations.