Wednesday, December 27, 2017

Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for the Medicare Advantage (MA) CMS-HCC Risk Adjustment Model

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:
  1. Drug Abuse, Uncomplicated, Except Cannabis (HCC 56)
  2. Reactive and Unspecified Psychosis (HCC 58 - the current HCC 58 will be renumbered as HCC 59)
  3. Personality Disorders (HCC 60)
  4. CKD Moderate, Stage 3 (HCC 138)

CMS also proposed the following changes to the CMS-HCC Risk Adjustment model

  1. 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). 
  2. 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.

Part II was released on February 1, 2018


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