CMS 2019 Final Call Letter

Announcement of Calendar Year (CY) 2019 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter    April 2, 2018

For payment year 2019, CMS will implement the updated CMS-HCC model without count variables that was provided in Part I of the Advance Notice for comparison.

"This model incorporates the proposed additional Chronic Kidney Disease, mental health, and substance use disorder conditions, updates the data years used to calibrate the model from 2013 diagnoses predicting 2014 cost to 2014 diagnoses predicting 2015 cost, and selects 2014 diagnoses for calibration with the CPT/HCPCS-based methodology that is used to select risk adjustment eligible diagnoses submitted to the encounter data system. "

See New Coefficients Below:

Encounter Data

CMS is also finalizing the proposal to calculate 2019 risk scores by adding 25% of the risk score

calculated using encounter data and FFS diagnoses (with inpatient RAPS data to supplement encounter data) and 75% of the risk score calculated using RAPS and FFS diagnoses.

 Download the entire Call Letter here