April 4, 2022
NOTE TO: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, and Other Interested Parties
Announcement of Calendar Year (CY) 2023 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies
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CMS-Hierarchical Condition Categories (CMS-HCC) Risk Adjustment Model: For CY 2023, CMS will continue to calculate 100 percent of the risk score for non-ESRD MA enrollees using the 2020 CMS-HCC model, as proposed in the CY 2023 Advance Notice. For CY 2023, CMS will continue to use the 2017 CMS-HCC risk adjustment model and associated frailty factors to calculate risk scores for participants in PACE organizations, as proposed in the CY 2023 Advance Notice.
End Stage Renal Disease (ESRD) Risk Adjustment Models for CY 2023: For CY 2023, CMS will implement updated versions of the CMS-HCC ESRD risk adjustment models to calculate risk scores for MA enrollees with ESRD, as proposed in the CY 2023 Advance Notice. The updated models are segmented by dual status and calibrated using an updated clinical version as well as updated data years. For CY 2023, CMS will continue to use the 2019 CMS-HCC ESRD risk adjustment models to calculate risk scores for participants in PACE organizations with ESRD.
RxHCC Risk Adjustment Model: For CY 2023, CMS will implement an updated version of the RxHCC risk adjustment model for organizations other than PACE that includes a clinical update to the RxHCCs based on International Classification of Diseases 10th Revision, Clinical Modification (ICD-10-CM) diagnosis codes, and an update to the data years used to calibrate the model. For PACE organizations, CMS will continue to use the 2020 RxHCC risk adjustment model to calculate Part D risk scores for CY 2023.