The 21st Century Cures Act requires changes to the risk adjustment model for aged and disabled beneficiaries enrolled in Medicare Advantage Part C plans beginning in calendar year 2019.
For 2019, the agency proposes adding mental health, substance use disorder and chronic kidney disease conditions to the risk adjustment model and taking into account the number of conditions that a beneficiary has under the payment model.
Read the 2019 Medicare Advantage Part I Advance Notice – Risk Adjustment on CMS.gov.
The advance notice also discusses an alternative risk adjustment model that would take into account all conditions that a beneficiary has, including those outside the payment model. CMS projects the proposed risk adjustment model would increase MA risk scores by 1.1% and result in less payment variance across MA contracts, while the alternative model would decrease risk scores by 0.28% and result in greater payment variance across plans. Read it in PDF format
Source: AHA Today