Report to Congress: Proposed Method of Incorporating Health Status Risk Adjusters211 into Medicare+Choice Payments

摘要

Under Section 1853(a)(3) of the Social Security Act as enacted by Section 4001 of211u001eSubtitle A of the Balanced Budget Act (BBA) of 1997, the Secretary of the 211u001eDepartment of Health and Human Services must implement a risk adjustment 211u001emethodology that accounts for variations in per capita costs based on health 211u001estatus and other demographic factors for payment (to Medicare+Choice 211u001eorganizations) starting no later than January 1, 2000. The Secretary must develop 211u001ea method of risk adjustment, submit a report of that method, and have that method 211u001eevaluated by an outside independent actuary of the actuarial soundness of the 211u001eproposal. In response to this BBA mandate, this document outlines the Health Care 211u001eFinancing Administrations (HCFA) risk adjustment methodology, describes the 211u001eintegration of risk adjustment into the Medicare+Choice payment system, and 211u001epresents estimated aggregate impacts resulting from this change.