Understanding Changes to the Medicare Advantage 2019 Risk Adjustment Model

Managed Health Care Connect May 7, 2018
Jay Baker

For the majority of medical groups across the country that contract with Medicare Advantage (MA) plans, the early release draft of 2019 Proposed Changes to the CMS-HCC

Risk Adjustment Model, and subsequent releases from CMS have put them on notice. These significant and complex proposed changes to the MA model will require plans—and their contracted medical groups—to make financial and clinical adjustments that will impact fiscal and operational processes.

Model Revision to Community MA Populations

Based on the 21st Century Cures Act signed by President Obama in December 2016, the new MA community model (v23) and risk scores must be modified to account for evaluating the addition of mental health, substance use disorder, and chronic kidney disease conditions. MA...