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
