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Impact of CMS Changes to the Medicare Advantage HCC Risk Adjustment Model for Payment Year 2019: Winners and Losers

The Centers for Medicare & Medicaid Services (CMS) uses risk adjustment models to determine capitated payments made to Medicare Advantage (MA) plans and makes periodic updates designed to improve the performance of the models. A key component of the risk adjustment models is the set of Hierarchical Condition Categories (HCCs) that CMS uses to determine payments to MA plans. This study assesses the impact of the most recent changes to the risk adjustment models.

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