April 4, 2022

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

<aside> 📔 Table of Contents


Table VIII-9. 2023 RxHCC Model Relative Factors for Continuing Enrollees

| Variable | Description Label | Community, Non-Low Income, Age≥65 | Community, Non-Low Income, Age<65 | Community, Low Income, Age≥65 | Community, Low Income, Age<65 | Institutional | | --- | --- | --- | --- | --- | --- | --- | | Female | | | | | | | | 0-34 Years | | - | 0.186 | - | 0.460 | 1.978 | | 35-44 Years | | - | 0.323 | - | 0.629 | 2.028 | | 45-54 Years | | - | 0.384 | - | 0.680 | 1.705 | | 55-59 Years | | - | 0.367 | - | 0.615 | 1.538 | | 60-64 Years | | - | 0.328 | - | 0.511 | 1.401 | | 65-69 Years | | 0.156 | - | 0.347 | - | 1.374 | | 70-74 Years | | 0.166 | - | 0.302 | - | 1.226 | | 75-79 Years | | 0.166 | - | 0.252 | - | 1.078 | | 80-84 Years | | 0.142 | - | 0.216 | - | 0.948 | | 85-89 Years | | 0.123 | - | 0.151 | - | 0.831 | | 90-94 Years | | 0.084 | - | 0.085 | - | 0.688 | | 95 Years or Over | | - | - | - | - | 0.489 | | Male | | | | | | | | 0-34 Years | | - | 0.200 | - | 0.498 | 2.005 | | 35-44 Years | | - | 0.253 | - | 0.573 | 1.875 | | 45-54 Years | | - | 0.305 | - | 0.573 | 1.671 | | 55-59 Years | | - | 0.329 | - | 0.532 | 1.460 | | 60-64 Years | | - | 0.334 | - | 0.476 | 1.308 | | 65-69 Years | | 0.190 | - | 0.319 | - | 1.239 | | 70-74 Years | | 0.177 | - | 0.286 | - | 1.088 | | 75-79 Years | | 0.180 | - | 0.252 | - | 1.021 | | 80-84 Years | | 0.125 | - | 0.238 | - | 0.936 | | 85-89 Years | | 0.043 | - | 0.171 | - | 0.819 | | 90-94 Years | | - | - | 0.123 | - | 0.700 | | 95 Years or Over | | - | - | 0.046 | - | 0.527 | | Originally Disabled Interactions with Sex | | | | | | |

| Variable | Description Label | Community, Non-Low Income, Age≥65 | Community, Non-Low Income, Age<65 | Community, Low Income, Age≥65 | Community, Low Income, Age<65 | Institutional | | --- | --- | --- | --- | --- | --- | --- | | Originally Disabled Female | | 0.063 | - | 0.206 | - | 0.113 | | Originally Disabled Male | | - | - | 0.139 | - | 0.113 | | Disease Coefficients | | | | | | | | RXHCC1 | HIV/AIDS | 4.759 | 5.738 | 4.549 | 4.793 | 2.773 | | RXHCC5 | Opportunistic Infections | 0.337 | 0.409 | 0.335 | 0.262 | 0.270 | | RXHCC15 | Chronic Myeloid Leukemia | 4.227 | 3.246 | 7.276 | 9.718 | 4.812 | | RXHCC16 | Multiple Myeloma and Other Hematologic Cancers | 6.793 | 7.563 | 5.853 | 6.233 | 2.065 | | RXHCC17 | Secondary Cancer of Bone and Kidney | 3.252 | 2.762 | 4.769 | 4.298 | 2.065 | | RXHCC18 | Secondary Cancer of Lung, Liver, Brain, and Other Sites | 1.202 | 1.097 | 1.595 | 1.569 | 0.527 | | RXHCC19 | Leukemias and Other Hematologic Cancers | 1.202 | 1.097 | 1.571 | 1.430 | 0.527 | | RXHCC20 | Lung, Kidney, and Other Cancers; Secondary Cancer of Lymph Nodes and Other Sites | 0.321 | 0.243 | 0.519 | 0.408 | 0.139 | | RXHCC21 | Lymphomas and Other Hematologic Cancers | 0.212 | 0.087 | 0.173 | 0.139 | 0.079 | | RXHCC22 | Prostate, Breast, Bladder, and Other Cancers and Tumors | 0.100 | 0.087 | 0.160 | 0.139 | 0.079 | | RXHCC30 | Diabetes with Complications | 0.562 | 0.606 | 0.733 | 0.964 | 0.607 | | RXHCC31 | Diabetes without Complication | 0.243 | 0.215 | 0.317 | 0.384 | 0.295 | | RXHCC40 | Alpha-1-Antitrypsin Deficiency | 2.036 | 4.326 | 3.156 | 4.271 | 0.504 | | RXHCC41 | Lysosomal Storage Disorders | 1.468 | 6.404 | 1.180 | 8.929 | 0.102 | | RXHCC42 | Acromegaly and Other Endocrine and Metabolic Disorders | 1.043 | 1.873 | 1.165 | 2.533 | 0.348 | | RXHCC43 | Pituitary, Adrenal Gland, and Other Endocrine and Metabolic Disorders | 0.062 | 0.165 | - | 0.141 | 0.068 | | RXHCC44 | Thyroid Disorders | 0.094 | 0.164 | 0.114 | 0.182 | 0.104 |

| Variable | Description Label | Community, Non-Low Income, Age≥65 | Community, Non-Low Income, Age<65 | Community, Low Income, Age≥65 | Community, Low Income, Age<65 | Institutional | | --- | --- | --- | --- | --- | --- | --- | | RXHCC47 | Disorders of Lipoid Metabolism | - | 0.019 | 0.069 | 0.121 | 0.068 | | RXHCC54 | Chronic Viral Hepatitis C | 0.317 | 0.363 | 0.453 | 0.359 | 0.434 | | RXHCC55 | Acute or Unspecified Viral Hepatitis C | 0.317 | 0.363 | 0.453 | 0.359 | 0.434 | | RXHCC56 | Chronic Viral Hepatitis B and Other Specified Chronic Viral Hepatitis | 0.307 | 0.443 | 0.748 | 0.446 | 0.170 | | RXHCC59 | Primary Biliary Cirrhosis | 1.168 | 1.131 | 0.860 | 1.030 | 0.664 | | RXHCC65 | Chronic Pancreatitis | 0.321 | 0.399 | 0.324 | 0.459 | 0.236 | | RXHCC66 | Pancreatic Disorders and Intestinal Malabsorption, Except Pancreatitis | 0.193 | 0.399 | 0.279 | 0.459 | 0.165 | | RXHCC67 | Inflammatory Bowel Disease | 0.527 | 0.464 | 0.693 | 1.522 | 0.285 | | RXHCC80 | Aseptic Necrosis of Bone | 0.150 | 0.155 | 0.104 | 0.180 | 0.092 | | RXHCC81 | Psoriatic Arthropathy | 0.598 | 0.446 | 2.668 | 4.203 | 1.374 | | RXHCC82 | Systemic Sclerosis | 0.620 | 0.463 | 0.859 | 1.160 | 0.288 | | RXHCC83 | Rheumatoid Arthritis and Other Inflammatory Polyarthropathy | 0.256 | 0.274 | 0.700 | 1.160 | 0.288 | | RXHCC84 | Systemic Lupus Erythematosus and Other Systemic Connective Tissue Disorders | 0.187 | 0.241 | 0.179 | 0.251 | 0.101 | | RXHCC87 | Osteoporosis, Vertebral and Pathological Fractures | 0.058 | 0.196 | 0.171 | 0.267 | - | | RXHCC95 | Sickle Cell Anemia | - | 0.296 | - | 0.882 | - | | RXHCC96 | Acquired Hemolytic, Aplastic, and Sideroblastic Anemias | 0.368 | 0.310 | 0.388 | 0.522 | 0.108 | | RXHCC98 | Hereditary Angioedema and Other Defects in the Complement System | 5.764 | 26.683 | 7.785 | 24.546 | 0.172 | | RXHCC99 | Immune Disorders | 0.650 | 0.500 | 0.773 | 0.730 | 0.433 | | RXHCC100 | Immune Thrombocytopenic Purpura | 0.157 | 0.041 | 0.667 | 0.775 | 0.436 | | RXHCC111 | Alzheimer's Disease | 0.096 | 0.038 | - | - | - | | RXHCC112 | Dementia, Except Alzheimer's Disease | 0.096 | 0.038 | - | - | - | | RXHCC130 | Schizophrenia and Other Psychosis | 0.285 | 0.297 | 0.435 | 0.826 | 0.193 | | RXHCC131 | Bipolar Disorders | 0.285 | 0.230 | 0.384 | 0.510 | 0.193 |

| Variable | Description Label | Community, Non-Low Income, Age≥65 | Community, Non-Low Income, Age<65 | Community, Low Income, Age≥65 | Community, Low Income, Age<65 | Institutional | | --- | --- | --- | --- | --- | --- | --- | | RXHCC132 | Depression | 0.114 | 0.129 | 0.149 | 0.242 | 0.128 | | RXHCC133 | Anxiety and Other Psychiatric Disorders | 0.061 | 0.110 | 0.083 | 0.187 | 0.054 | | RXHCC146 | Profound or Severe Intellectual Disability/Developmental Disorder | 0.342 | 0.187 | 0.470 | 0.374 | - | | RXHCC147 | Moderate Intellectual Disability/Developmental Disorder | 0.342 | - | 0.279 | 0.177 | - | | RXHCC148 | Mild or Unspecified Intellectual Disability/Developmental Disorder | 0.342 | - | 0.116 | 0.057 | - | | RXHCC153 | Myasthenia Gravis and Other Myoneural Disorders | 0.658 | 1.243 | 0.789 | 1.108 | 0.214 | | RXHCC154 | Amyotrophic Lateral Sclerosis and Other Motor Neuron Disease | 0.431 | 0.727 | 0.262 | 0.742 | 0.129 | | RXHCC155 | Spinal Cord Disorders | 0.094 | 0.080 | 0.053 | - | 0.018 | | RXHCC157 | Chronic Inflammatory Demyelinating Polyneuritis | 1.865 | 3.217 | 2.353 | 3.362 | 0.775 | | RXHCC158 | Inflammatory and Toxic Neuropathy | - | 0.055 | - | 0.068 | 0.079 | | RXHCC159 | Multiple Sclerosis | 2.185 | 3.075 | 2.195 | 3.908 | 1.122 | | RXHCC160 | Huntington Disease | 2.140 | 2.683 | 1.441 | 2.290 | 1.310 | | RXHCC161 | Parkinson Disease | 0.537 | 0.676 | 0.369 | 0.431 | 0.318 | | RXHCC163 | Intractable Epilepsy | 0.355 | 0.490 | 0.503 | 1.505 | 0.273 | | RXHCC164 | Epilepsy and Other Seizure Disorders, Except Intractable Epilepsy | 0.117 | 0.068 | 0.068 | 0.177 | 0.037 | | RXHCC166 | Migraine Headaches | 0.135 | 0.194 | 0.159 | 0.200 | 0.158 | | RXHCC168 | Trigeminal and Postherpetic Neuralgia | 0.124 | 0.257 | 0.201 | 0.245 | 0.207 | | RXHCC183 | Pulmonary Arterial Hypertension | 0.720 | 2.150 | 0.896 | 2.946 | 0.382 | | RXHCC184 | Pulmonary Hypertension, Except Arterial, and Other Pulmonary Heart Disease | 0.228 | 0.313 | 0.270 | 0.324 | 0.241 | | RXHCC186 | Heart Failure | 0.210 | 0.148 | 0.270 | 0.195 | 0.234 | | RXHCC187 | Hypertension | 0.111 | 0.059 | 0.188 | 0.128 | 0.103 |

| Variable | Description Label | Community, Non-Low Income, Age≥65 | Community, Non-Low Income, Age<65 | Community, Low Income, Age≥65 | Community, Low Income, Age<65 | Institutional | | --- | --- | --- | --- | --- | --- | --- | | RXHCC188 | Coronary Artery Disease | 0.090 | 0.027 | 0.151 | - | - | | RXHCC191 | Ventricular Septal Defect and Major Congenital Heart Disorders | 0.066 | 0.333 | 0.209 | 0.124 | 0.140 | | RXHCC193 | Atrial Arrhythmias | 0.602 | 0.236 | 0.398 | 0.165 | 0.267 | | RXHCC207 | Spastic Hemiplegia | 0.224 | 0.186 | 0.135 | 0.096 | - | | RXHCC215 | Venous Thromboembolism | 0.398 | 0.366 | 0.309 | 0.320 | 0.275 | | RXHCC225 | Cystic Fibrosis | 2.109 | 10.674 | 1.206 | 12.646 | 0.514 | | RXHCC226 | Idiopathic Pulmonary Fibrosis and Systemic Sclerosis with Lung Involvement | 2.616 | 2.097 | 2.556 | 2.101 | 0.748 | | RXHCC227 | Pulmonary Fibrosis, Except Idiopathic | 0.365 | 0.396 | 0.449 | 0.715 | 0.271 | | RXHCC228 | Severe Persistent Asthma | 1.027 | 0.679 | 1.216 | 1.136 | 0.616 | | RXHCC229 | Chronic Obstructive Pulmonary Disease, Bronchiectasis, and Other Asthma | 0.365 | 0.194 | 0.449 | 0.343 | 0.271 | | RXHCC243 | Glaucoma, Open-Angle or Moderate/Severe Stage | 0.304 | 0.251 | 0.430 | 0.384 | 0.320 | | RXHCC244 | Other Non-Acute Glaucoma | 0.059 | - | 0.104 | - | 0.080 | | RXHCC260 | Kidney Transplant Status | 0.208 | - | 0.172 | - | - | | RXHCC261 | Dialysis Status, Including End Stage Renal Disease | 0.083 | 0.056 | 0.123 | 0.176 | 0.081 | | RXHCC262 | Chronic Kidney Disease Stage 5 | 0.083 | 0.056 | 0.123 | 0.082 | 0.081 | | RXHCC263 | Chronic Kidney Disease Stage 4 | 0.083 | 0.056 | 0.123 | 0.082 | 0.081 | | RXHCC311 | Chronic Ulcer of Skin, Except Pressure | 0.174 | 0.203 | 0.141 | 0.192 | 0.081 | | RXHCC314 | Pemphigus, Pemphigoid, and Other Bullous Skin Disorders | 0.274 | 0.601 | 0.318 | 0.506 | 0.182 | | RXHCC316 | Psoriasis, Except with Arthropathy | 0.144 | 0.143 | 0.713 | 1.309 | 0.431 | | RXHCC317 | Discoid Lupus Erythematosus | 0.129 | 0.141 | - | - | - | | RXHCC355 | Narcolepsy and Cataplexy | 0.752 | 1.409 | 0.679 | 1.475 | 0.359 | | RXHCC395 | Stem Cell, Including Bone Marrow, Transplant Status/Complications | 2.111 | 1.083 | 2.846 | 1.748 | 1.120 | | Variable | Description Label | Community, Non-Low Income, Age≥65 | Community, Non-Low Income, Age<65 | Community, Low Income, Age≥65 | Community, Low Income, Age<65 | Institutional | | RXHCC396 | Heart, Lung, Liver, Intestine, or Pancreas Transplant Status | 0.208 | - | 0.172 | - | - |

NOTE: The Part D denominator used to calculate relative factors is $1,137.46. This Part D Denominator is based on the combined PDP and MA-PD populations.

SOURCE: RTI Analysis of 100% 2018–2019 Medicare Enrollment Data, 2019 Prescription Drug Event (PDE) Data, 2018 Professional Claims (Carrier), 2018 Inpatient Claims, 2018 Outpatient Claims, and 2018 Medicare Advantage Encounter Data.

Table VIII-10. 2023 RxHCC Model Relative Factors for New Enrollees, Non-Low Income

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NOTES:

  1. The Part D Denominator used to calculate relative factors is $1,137.46. This Part D Denominator is based on the combined PDP and MA-PD populations.
  2. Originally Disabled is defined as originally entitled to Medicare by disability only (OREC = 1).