April 4, 2022
Attachment VIII. 2023 CMS-HCC ESRD and 2023 RxHCC Risk Adjustment Model Relative Factors
<aside> 📔 Table of Contents
Variable | Description Label | Relative Factors |
---|---|---|
Female | ||
0-34 Years | 0.644 | |
35-44 Years | 0.630 | |
45-54 Years | 0.564 | |
55-59 Years | 0.570 | |
60-64 Years | 0.569 | |
65-69 Years | 0.630 | |
70-74 Years | 0.624 | |
75-79 Years | 0.617 | |
80-84 Years | 0.661 | |
85-89 Years | 0.629 | |
90-94 Years | 0.629 | |
95 Years or Over | 0.629 | |
Male | ||
0-34 Years | 0.616 | |
35-44 Years | 0.604 | |
45-54 Years | 0.551 | |
55-59 Years | 0.557 | |
60-64 Years | 0.569 | |
65-69 Years | 0.577 | |
70-74 Years | 0.551 | |
75-79 Years | 0.601 | |
80-84 Years | 0.635 | |
85-89 Years | 0.635 | |
90-94 Years | 0.635 | |
95 Years or Over | 0.635 | |
Medicaid, Originally Disabled, and Originally ESRD Interactions with Age and Sex | ||
FBDual_Female_Aged | 0.060 | |
FBDual_Female_NonAged (Age <65) | 0.082 | |
FBDual_Male_Aged | 0.128 | |
FBDual_Male_NonAged (Age <65) | 0.076 | |
PBDual_Female_Aged | – | |
PBDual_Female_NonAged (Age <65) | – | |
PBDual_Male_Aged | – | |
PBDual_Male_NonAged (Age <65) | – | |
Originally Disabled_Female2 | 0.024 | |
Originally Disabled_Male2 | – | |
Originally ESRD_Female3 | -0.024 | |
Originally ESRD_Male3 | 0.017 |
Variable | Description Label | Relative Factors |
---|---|---|
Institutional Status Factors | ||
Institutional, Aged (65+) | 0.020 | |
Institutional, NonAged (<65) | 0.098 | |
Disease Coefficients | ||
HCC1 | HIV/AIDS | 0.122 |
HCC2 | Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock | 0.087 |
HCC6 | Opportunistic Infections | 0.076 |
HCC8 | Metastatic Cancer and Acute Leukemia | 0.353 |
HCC9 | Lung and Other Severe Cancers | 0.181 |
HCC10 | Lymphoma and Other Cancers | 0.111 |
HCC11 | Colorectal, Bladder, and Other Cancers | 0.059 |
HCC12 | Breast, Prostate, and Other Cancers and | |
Tumors | 0.045 | |
HCC17 | Diabetes with Acute Complications | 0.084 |
HCC18 | Diabetes with Chronic Complications | 0.084 |
HCC19 | Diabetes without Complication | 0.084 |
HCC21 | Protein-Calorie Malnutrition | 0.068 |
HCC22 | Morbid Obesity | 0.081 |
HCC23 | Other Significant Endocrine and Metabolic Disorders | 0.036 |
HCC27 | End-Stage Liver Disease | 0.196 |
HCC28 | Cirrhosis of Liver | 0.069 |
HCC29 | Chronic Hepatitis | 0.061 |
HCC33 | Intestinal Obstruction/Perforation | 0.078 |
HCC34 | Chronic Pancreatitis | 0.068 |
HCC35 | Inflammatory Bowel Disease | 0.048 |
HCC39 | Bone/Joint/Muscle Infections/Necrosis | 0.092 |
HCC40 | Rheumatoid Arthritis and Inflammatory Connective Tissue Disease | 0.058 |
HCC46 | Severe Hematological Disorders | 0.223 |
HCC47 | Disorders of Immunity | 0.078 |
HCC48 | Coagulation Defects and Other Specified Hematological Disorders | 0.063 |
HCC51 | Dementia With Complications | 0.042 |
HCC52 | Dementia Without Complication | 0.042 |
HCC54 | Substance Use with Psychotic Complications | 0.111 |
HCC55 | Substance Use Disorder, Moderate/Severe, or Substance Use with Complications | 0.111 |
HCC56 | Substance Use Disorder, Mild, Except Alcohol and Cannabis | 0.111 |
Variable | Description Label | Relative Factors |
---|---|---|
HCC57 | Schizophrenia | 0.111 |
HCC58 | Reactive and Unspecified Psychosis | 0.111 |
HCC59 | Major Depressive, Bipolar, and Paranoid Disorders | 0.066 |
HCC60 | Personality Disorders | 0.066 |
HCC70 | Quadriplegia | 0.185 |
HCC71 | Paraplegia | 0.151 |
HCC72 | Spinal Cord Disorders/Injuries | 0.099 |
HCC73 | Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease | 0.213 |
HCC74 | Cerebral Palsy | 0.057 |
HCC75 | Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy | 0.074 |
HCC76 | Muscular Dystrophy | 0.136 |
HCC77 | Multiple Sclerosis | 0.111 |
HCC78 | Parkinson's and Huntington's Diseases | 0.079 |
HCC79 | Seizure Disorders and Convulsions | 0.053 |
HCC80 | Coma, Brain Compression/Anoxic Damage | 0.076 |
HCC82 | Respirator Dependence/Tracheostomy Status | 0.161 |
HCC83 | Respiratory Arrest | 0.112 |
HCC84 | Cardio-Respiratory Failure and Shock | 0.061 |
HCC85 | Congestive Heart Failure | 0.063 |
HCC86 | Acute Myocardial Infarction | 0.151 |
HCC87 | Unstable Angina and Other Acute Ischemic Heart Disease | 0.120 |
HCC88 | Angina Pectoris | 0.043 |
HCC96 | Specified Heart Arrhythmias | 0.049 |
HCC99 | Intracranial Hemorrhage | 0.062 |
HCC100 | Ischemic or Unspecified Stroke | 0.062 |
HCC103 | Hemiplegia/Hemiparesis | 0.071 |
HCC104 | Monoplegia, Other Paralytic Syndromes | 0.047 |
HCC106 | Atherosclerosis of the Extremities with Ulceration or Gangrene | 0.358 |
HCC107 | Vascular Disease with Complications | 0.144 |
HCC108 | Vascular Disease | 0.073 |
HCC110 | Cystic Fibrosis | 0.125 |
HCC111 | Chronic Obstructive Pulmonary Disease | 0.058 |
HCC112 | Fibrosis of Lung and Other Chronic Lung Disorders | 0.058 |
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NOTES:
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