CMS Risk Adjustment Data Collection
Investment ID: 009-000281595
Overview
Program Title
CMS Risk Adjustment Data Collection
Description
This investment funds ongoing operations and maintenance of the Risk Adjustment Suite of Systems (RASS) that provides critical risk adjustment factors to the Medicare Advantage Prescription Drug System (MARx) for payment calculations. RASS currently consists of the Risk Adjustment Processing System (RAPS), the Risk Adjustment System (RAS), the RAPS User Interface (UI), the Encounter Data Risk Adjustment database (EDRA), and the Adjusted Monthly Membership Report (AMMR) Process System, as well as the Interface to the Integrated Data Repository (IDR). This investment also funds cloud hosting and associated tools so that the RASS can operate in the AWS environment.
Type of Program
Major IT Investments
Multi-Agency Category
Not Applicable
Investment Detail
This investment funds the Risk Adjustment Suite of Systems (RASS) ongoing system operations and maintenance, necessary system enhancements, cloud hosting and supporting contracts for the risk adjustment function. RASS receives, processes and stores risk adjustment data, and uses the HCC and Part D models developed by CMS to calculate risk scores used to risk adjust MA plan payments. RASS produces the risk adjustment factors for use by the Medicare Advantage Prescription Drug System (MARx) payment system to calculate beneficiary level payments, and provides these critical risk adjustment factors to MARx for payment calculations. RASS currently consists of: Risk Adjustment Processing System (RAPS), Risk Adjustment System (RAS), RAPS User Interface (UI), and Encounter Data Risk Adjustment (EDRA) database with encounter data extracted from the Integrated Data Repository (IDR). RASS has completed extensive efforts to progressively modernize and migrate applications to a modern cloud based architecture with minimal or no risk to business operations. This migration supports the OIT goal to Lead IT Modernization that protects our Infrastructure. Extensive analysis was conducted and it was determined that migrating RASS from the mainframe BDC to AWS would result in significant cost reduction to both the RASS maintainer and CMS datacenter costs. CMS made the decision to have the RASS contractor migrate the system to the AWS using a phased approach. The RASS team is currently in the process of assessing the benefits and realized value of this modernization and migration effort.