Common use of Risk Adjustment Methodology Clause in Contracts

Risk Adjustment Methodology. A. The Medicare A/B Demonstration county rate will be risk adjusted based on the risk profile of each enrolled beneficiary. Except as specified in section II.B.g of this Appendix for calendar year 2013, the existing CMS-HCC risk adjustment methodology will be utilized for the Demonstration. B. The Medicare Part D national average bid will be risk-adjusted in accordance with existing Part D RxHCC methodology. C. The Medicaid component will be risk adjusted based on a methodology proposed by the Commonwealth and agreed to by CMS as described below: Under the Massachusetts Demonstration to Integrate Care for Dual Eligible Beneficiaries, the Commonwealth will rely on rating categories described in section I and use High Cost Risk Pools (HCRPs) for certain Rating Categories described in section IX to account for differences in risk among the eligible population. D. The Commonwealth will be collecting functional data and will be working on the development of an enhanced risk adjustment methodology for the Medicaid component of the rate during the course of the Demonstration.

Risk Adjustment Methodology. A. The Medicare A/B Demonstration county rate will be risk adjusted based on the risk profile of each enrolled beneficiary. Except as specified in section II.B.g of this Appendix for calendar year 2013, the existing CMS-HCC risk adjustment methodology will be utilized for the Demonstration. B. . The Medicare Part D national average bid will be risk-adjusted in accordance with existing Part D RxHCC methodology. C. . The Medicaid component will be risk adjusted based on a methodology proposed by the Commonwealth and agreed to by CMS as described below: Under the Massachusetts Demonstration to Integrate Care for Dual Eligible Beneficiaries, the Commonwealth will rely on rating categories described in section I and use High Cost Risk Pools (HCRPs) for certain Rating Categories described in section IX to account for differences in risk among the eligible population. D. . The Commonwealth will be collecting functional data and will be working on the development of an enhanced risk adjustment methodology for the Medicaid component of the rate during the course of the Demonstration.