Risk Adjustment

CMS Medicare Risk Adjustment CY2018 Advance Notice

As always, this release details the modifications CMS intends to make to the Part C and Part D programs.  These plans are open to public comment, and the Final Announcement will be expected in early April.

The segmentation of the Part C model into six Community segments (based upon Medicaid eligibility and aged/disabled status) remains in place and can be expected to persist in the future.  Medicare Advantage Organizations continue to be required to consider separate coefficients for each segment for all Hierarchical Condition Categories and demographic factors.  As before, the institutional segment remains intact.

The diagnostic and coefficient details of the CMS-HCC model are proposed for any modification through this Advance Notice, which may be a relief to those organizations which found it difficult to transition through the “blended model” period.  The 2017 model, released last April, remains in effect.   From the standpoint of HCC coding, no changes are required.

CMS has adjusted the Normalization and Coding Intensity Factors.  CMS also indicates that the computation of RAF scores will remain 75% based upon RAPS submissions and 25% upon EDPS submissions, again unchanged from the 2017 letter.

CMS does propose to update the Part D (Rx-HCC) model.  New coefficients for 2018 are incorporated into the Advance Notice (pp. 57).  The Rx-HCC model remains separated into five segments, as in previous years.

Finally, CMS continues to refine and update the Stars Measures in pursuit of the Centers’ stated goal of improving quality of care and health statuses.  Detailed technical specifications for these measures are available on CMS’s website: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html

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