UMMS Affiliation

Department of Quantitative Health Sciences

Date

10-21-2004

Document Type

Article

Medical Subject Headings

Adolescent; Adult; Aged; Aged, 80 and over; *Capitation Fee; Centers for Medicare and Medicaid Services (U.S.); Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; International Classification of Diseases; Male; Medicare Part C; Middle Aged; Models, Organizational; *Risk Adjustment; United States

Disciplines

Biostatistics | Epidemiology | Health Services Research

Abstract

This article describes the CMS hierarchical condition categories (HCC) model implemented in 2004 to adjust Medicare capitation payments to private health care plans for the health expenditure risk of their enrollees. We explain the model's principles, elements, organization, calibration, and performance. Modifications to reduce plan data reporting burden and adaptations for disabled, institutionalized, newly enrolled, and secondary payer subpopulations are discussed.

Rights and Permissions

Citation: Health Care Financ Rev. 2004 Summer;25(4):119-41. Link to article on publisher's site

Related Resources

Link to Article in PubMed

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