Benefit Year
. A calendar year or the
applicable portion of a calendar year during which the Risk Adjustment Program
is operated.
Carrier
. A Carrier, as defined in
M.G.L. c. 176M, § 1, that offers at least one Risk Adjustment Covered Plan
in the Commonwealth.
CHIA. The Center for Health
Information and Analysis established in M.G.L. c. 12C.
Commonwealth. The Commonwealth of
Massachusetts.
The Connector
. The Commonwealth Health
Insurance Connector Authority.
Massachusetts All Payer Claims Database or MA
APCD. The All Payer Claims Database maintained by CHIA to which
payers are required to submit data under
957 CMR 8.00: All
Payer Claims Database (APCD) and Case Mix and Charge Data
Submission.
Member Month Tracker Report
. A report
provided by the Connector to each Carrier including calculations of the total
member months of enrollment subject to risk adjustment and collected premiums,
based on the data submitted to the MA APCD by Carriers for the applicable
reporting period.
Final Risk Adjustment Payments and Charges
Report. The annual report to be sent by the Connector to Carriers,
by June 30th of the year following the applicable
Benefit Year, describing charges owed by or payments owed to the Carrier under
the Risk Adjustment program, as well as the list of data elements used in
creating the risk adjustment data extract, the data extracts themselves,
algorithms used to calculate payments and charges, and the output datasets from
the algorithms.
Quarterly Simulation Reports
. A set of
reports provided to each Carrier on a quarterly basis, providing preliminary
calculations and data regarding the Carrier's risk adjustment experience. These
shall include data quality assessment reports, as well as reports from the
Connector regarding the data elements and algorithms used in developing the
Risk Adjustment Data Extract and in calculating risk scores and preliminary
transfer amounts, based on the data available for the applicable reporting
period, and other data relevant to discrepancy resolution.
Risk Adjustment Covered Plan
. Any
health insurance coverage offered in the individual or small group market in
Massachusetts, as well as any other coverage specified as being subject to the
Risk Adjustment Program in the applicable State Payment Notice, with the
exception of: grandfathered health plans; coverage that is considered "excepted
benefits" under 45 CFR § 146.145(c) or 45 CFR § 148.220; and any plan
determined not to be a risk adjustment covered plan in the applicable State
Payment Notice.
Risk Adjustment Data Extract
. An
extract of health plan data reported to CHIA under
957 CMR 8.00: All
Payer Claims Database (APCD) and Case Mix and Charge Data Submission,
containing only data elements that are necessary for risk adjustment, provided
by CHIA to the Connector to conduct risk adjustment operations.
Risk Adjustment Methodology
. The
federally certified risk adjustment methodology that will be implemented in the
Commonwealth for a particular Benefit Year.
Risk Adjustment Program
. The risk
mitigation program operated by the Connector, pursuant to the authority granted
M.G.L. c. 176Q, § 3(v), as described in 42 U.S.C. § 18063, and as
implemented in
956 CMR 13.00.
State Payment Notice
. The
Massachusetts Notice of Benefit and Payment Parameters, released by the
Connector, describing the parameters, procedures, and methodology for Risk
Adjustment for a given Benefit Year.
