Transcription of Potential HHS-HCC Updates for Risk Adjustment Program
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Potential HHS-HCC Updates for Risk Adjustment Program
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Center for Consumer Information & Insurance Oversight 200 Independence Avenue SW Washington, DC 20201 Potential Updates to HHS-HCCs for the HHS-operated Risk Adjustment Program June 17, 2019 EXECUTIVE SUMMARY .. 1 Table Overview of Potential Changes across Adult, Child and Infant Models .. 3 Table Summary of V06a HHS-HCC Risk Adjustment Model Changes .. 4 Overview .. 6 Purpose and Structure of this Paper .. 6 Purpose of ICD-10 Reclassification .. 6 Other Revisions to the Clinical Classification .. 7 Outside the Scope of this Clinical Reclassification .. 8 Brief Overview of HHS-HCC Diagnostic Classification and Criteria .. 8 Criteria .. 8 Overall Framework .. 9 Elements .. 9 Review and Reclassification Process .. 13 Potential V06a HHS-HCC Classification Updates .. 16 Summary.
Exudative Macular Degeneration +1 - Add HCC to adult model because currently underpredicted; costs are primarily related to drug treatments. Congenital Heart Anomalies new to adult - Add 3 underpredicted HCCs to adult model (already in the child and infant models). Group them in the adult model only.
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