February 2, 2022
SUBJECT: Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies
<aside> 📔 Table of Contents
| V21 | V24 |
|---|---|
| Classification of Payment HCCs | |
| • 79 payment HCCs included in the ESRD models | |
| • V21 includes more diagnoses in HCC 75 Polyneuropathy than V24 counterpart HCC 75 Myasthenia Gravis…Toxic Neuropathy | • 81 payment HCCs included in the ESRD models |
| • V21 has two payment substance use disorder HCCs 54–55 | • V24 has three payment substance use disorder HCCs 54–56, reconfigured differently from V21 with an expanded set of diagnosis codes |
| • V21 has two payment psychiatric disorder HCCs 57–58 | • V24 has four payment psychiatric disorder HCCs 57–60, adding |
| HCC 58 Reactive and Unspecified Psychosis and | |
| HCC 60 Personality Disorders; | |
| HCC 59 Major Depressive, Bipolar, and Paranoid Disorders was renumbered (had been HCC 58) and moved down in the payment hierarchy below V24 HCC 58 | |
| • V21 has four payment pressure ulcer HCCs (157–160), including HCC 160 Pressure Pre-Ulcer Skin Changes or Unspecified Stage | • V24 has three payment pressure ulcer HCCs (157–159) |
| • V21 disease-disease interaction SepsisCardiorespiratory Failure* is not in V24; all others are the same conceptually, although the group definition differs for this group: | |
| o V21 COPD group has HCCs 110– 111 | • V24 community non-aged segments have an additional disease-disease interaction, Substance Use Disorder Psychiatric*, which will be used in the functioning graft community non-aged segments. In the continuing enrollee dialysis model, it will be applied as a non-aged interaction. • V24 disease-disease interaction Congestive Heart FailureSpecified Heart Arrhythmias* is not in V21; all others are the same conceptually, although the group definition differs for this group: |
| o V24 COPD group has HCCs 110– 112 | |
| • V21 has seven non-aged disease interactions for these HCCs: o HCC 6 Opportunistic Infections | |
| o HCC 34 Chronic Pancreatitis | |
| o HCC 46 Severe Hematological Disorders | |
| o HCC 54 Drug/Alcohol Psychosis | |
| o HCC 55 Drug/Alcohol Dependence | |
| o HCC 110 Cystic Fibrosis | |
| o HCC 176 Complications of Specified Implanted Device or Graft | • Because V24 community has segment breakouts for the non-aged, it does not have non-aged-disease interactions. The non-segmented continuing enrollee dialysis model will have non-aged disease interactions for five HCCs: 6, 34, 46, 110, and 176. |
| • V21 institutional disease-disease and non-aged-disease interactions are the same as in V24 except for the definition of these two groups: | |
| o V21 COPD group has HCCs 110–111 | |
| o V21 Pressure Ulcer group has HCCs 157–160 | • V24 institutional disease-disease and non-aged-disease interactions are the same as V21 except for the definition of these two groups: |
| o V24 COPD group has HCCs 110–112 | |
| o V24 Pressure Ulcer group has HCCs 157–159 |
| Segments | |
|---|---|
| • V21 continuing enrollee dialysis: combined community and institutional sample is large enough to estimate a stable single segment model. | • V24 continuing enrollee dialysis: propose to continue using a single combined community and institutional segment, adding two institutional status variables to better distinguish costs for that subpopulation |
| • V21 functioning graft: the functioning graft population’s combined community and institutional sample is not large enough to estimate a stable single segment model; the underlying aged/non-aged models are used and four functioning graft factors are independently estimated. | • V24 functioning graft community: The underlying models for the non-ESRD population segments are used with functioning graft factors that are independently estimated using the functioning graft population. We propose to break out the functioning graft community model into four segments, using the non-ESRD population segments as a base, as listed below |
| o Non-dual / partial benefit dual aged | |
| o Non-dual / partial benefit dual non-aged | |
| o Full benefit dual aged | |
| o Full benefit dual non-aged |