Part D Payment and Risk Adjustment

This page provides information on the following areas:

  • Information on the final risk adjustment model.
  • Part D guidance on the demonstration concept first articulated in the February 25, 2005 Federal Register notice on the Part D Reinsurance Payment Demonstration.
  • Links to the final 2006 Medicare Advantage Rates Notice with Part D payment methods including the official version of the final Part D risk adjustment model and the Advance Notice of 2006 rates with the proposed Part D payment methodology.

The final risk adjustment model for Part D is described in the attached Excel file.  The official version of the final Part D risk adjustment model was published on April 4, 2005 in the final 2006 Medicare Advantage Rates Notice.  The file consists of the following 7 worksheets:

  1. An introduction with descriptive information about the other worksheets.
  2. The mapping of ICD-9-CM codes into disease groups (RXHCCs).
  3. The final risk model for plan liability with relative risk factors for each RXHCC and the long-term multiplicative factors.
  4. A new enrollee plan liability model used for payment.
  5. The hierarchical clustering of disease groups.
  6. A reference risk model for spending (not used for payment).
  7. An informational only new enrollee spending model (not used for payment).

Click the selection that best matches your information needs.  Please check back, as we will continue to update these resources regularly.

Page Last Modified:
12/01/2021 07:02 PM