Tuesday, January 5, 2016

CDPS Risk Adjustment

What is the CDPS Model?

The Chronic Illness and Disability Payment System was built to adjust capitated payments (based on estimated health burden) to health plans that involved Medicaid beneficiaries.

What is the Purpose?

  • To make equitable comparisons among health plans that take the health status of their enrolled members into consideration.
  • Minimize the incentives for plans and providers from selectively enrolling healthier members.
  • Provide adequate funding for those who treat individuals with higher than average health needs

Which States are Using CDPS?

How Does it Work?

CDPS is similar to models used for Medicare (CMS-HCC), but places a greater emphasis on less common, but costly chronic conditions that are more prevalent among disabled Medicaid beneficiaries.

The model maps ICD-9 / ICD-10 codes to 58 CDPS categories within 20 major categories corresponding to major body systems (e.g. cardiovascualar) or type of disease (e.g. diabetes).

CDPS includes weights for disabled, TANF Adults, and TANF Children, Prospective and Concurrent.

What are the 58 CDPS Categories?


Where Can I Download the Model?

Where Can I Learn More?

Test Your Skills and Play CDPS from mHealth Games Today!
  • Level 1 – Brief Overview and History of CDPS
  • Level 2 – Mechanics of CDPS Risk Adjustment
  • Level 3 – Application of Knowledge

    Click on the picture above to launch the game,

Or use one of the links below:


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