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2011 Report: Evaluation of the CMS-HCC Risk Adjustment Model

The 2010 Patient Protection and Affordable Care Act (Public Law No: 111-148) includes several sections affecting the Medicare Program. Specifically, Sec. 3205 focuses on Medicare Advantage (MA) plans for special needs individuals. Within that section of the legislation, “item (f) Risk Adjustment” contains revisions to the Social Security Act, including a new clause that mandates 1) an evaluation of the Centers for Medicare & Medicaid Services (CMS) risk adjustment system used to account for medical expenditures and care coordination costs for specified subsets of beneficiaries; and 2) a publication of that evaluation and any changes occurring as a result of the evaluation.