April 4, 2022

Attachment VIII. 2023 CMS-HCC ESRD and 2023 RxHCC Risk Adjustment Model Relative Factors

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Table VIII-1. 2023 CMS-HCC ESRD Model Continuing Enrollee Dialysis Relative Factors

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:

  1. The CMS-HCC ESRD Dialysis Denominator used to calculate the relative factors is $87,250.85.
  2. Originally Disabled indicates beneficiary originally entitled to Medicare for reasons of disability other than ESRD.
  3. Originally ESRD indicates beneficiary originally entitled to Medicare due to ESRD. Beneficiaries who are Originally ESRD cannot be Originally Disabled.
  4. All HCCs in the kidney disease hierarchy (HCCs 134-138) and the disease interaction term involving renal disease (congestive heart failure*renal) are constrained to zero.
  5. In the "disease interactions," the variables are defined as follows:

Table VIII-2. 2023 CMS-HCC ESRD Model Demographic Relative Factors for New Enrollees in Dialysis Status

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NOTES:

  1. The CMS-HCC ESRD Dialysis Denominator used to calculate the relative factors is $87,250.85.