The Centers for Medicare & Medicaid Services (CMS) released Part I of the 2019 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part D Payment Policies (the Advance Notice), on December 27, 2017, which contains key information about proposed updates to the Part C Risk Adjustment Model and the use of encounter data.
The following HCC Categories were proposed:
- Drug Abuse, Uncomplicated, Except Cannabis (HCC 56)
- Reactive and Unspecified Psychosis (HCC 58 - the current HCC 58 will be renumbered as HCC 59)
- Personality Disorders (HCC 60)
- CKD Moderate, Stage 3 (HCC 138)
CMS also proposed the following changes to the CMS-HCC Risk Adjustment model
- Add selected drug and alcohol “poisoning” (overdose) codes to existing “Drug/Alcohol Dependence,” to create “Drug/Alcohol Dependence, or Abuse/Use with Complications” (HCC 55).
- Add new factors to the six community and single long term institutional (LTI) segments that take into account a beneficiary’s number of conditions that are in the payment model.
You can view the entire notice here: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Advance2019Part1.pdf
Part II was released on February 1, 2018
View Part II of this notice here: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Advance2019Part2.pdf