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2014 HCC Model Changes

The CMS-HCC risk adjustment model is used to adjust payments for Part C benefits offered by Medicare Advantage plans. On April 1, 2013, CMS issued the 2014 Rate Announcement and Final Call letter for MA and Part D programs. Moving from HCC Model 12 to HCC Model 22 for PY2014—for risk adjustment purposes—was one of the new changes. Several HCC's fell off, were added, or changed in the new model. This model was expected to be fully phased-in by January 1, 2015 but has since been delayed. For PY2014, CMS used a blended risk score for each member by taking 25% of the 2013 HCC Model 12 and 75% of the 2014 HCC Model 22. Cognisight highlighted several of the changes in a webinar offered to clients.

To download the webinar slides, please click here.