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?
- Level 1 – Brief Overview and History of CDPS
- Level 2 – Mechanics of CDPS Risk Adjustment
- Level 3 – Application of Knowledge
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