January 07, 2020
On January 6, 2019, the Centers for Medicare and Medicaid Services (CMS) released Part I of the 2021 Advance Notice limited to the risk adjustment methodology per the annual cycle of Medicare Advantage (MA) regulatory guidelines for the coming year. The proposal generally follows the approach CMS outlined last year, phasing in changes pursuant to the 21st Century Cures Act and the use of encounter data as a diagnosis source.
Under the proposal for 2021, encounter data will increase to 75% of the risk score using the 2020 CMS-HCC model, and 25% will be based on RAPS using the 2017 CMS-HCC model. This compares to a 50/50 split for 2020. CMS estimates that the change would increase risk scores by .25% with a $565.5 million cost to the government.
The second part of the Advance Notice is expected on or before February 6, with the final announcement required by April 6.