The Centers for Medicare and Medicaid Services (CMS) released the Calendar Year 2024 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies (the Rate Announcement) on March 31. In comments to CMS submitted March 1, the ACC expressed concern for unintended consequences from the proposed changes to the Hierarchical Condition Categories (HCC), which would impact several disease types including diabetes, congestive heart failure, angina pectoris and atherosclerosis of arteries of the extremities with intermittent claudication.

CMS has opted to finalize the updated risk adjustment model proposed in the 2024 Advance Notice, but will phase the updated model in over a three-year period. For 2024, risk scores will be calculated as a blend of 67% with the 2020 model and 33% with the updated 2024 model. For 2025, risk scores are expected to be calculated as a blend of 33% with the 2020 model and 67% with the 2024 model, and 100% of the risk scores are expected to be calculated with the 2024 model in 2026.

The agency also provided additional rationale of their selection of HCC changes and the anticipated impacts. For more information, access ACC’s comment letter and a CMS factsheet on the Rate Announcement. ACC Advocacy staff continue to review the announcement for more details and assessment.

Keywords: Diabetes Mellitus, Policy, Extremities, Angina Pectoris, Atherosclerosis, Arteries, Medicaid, Centers for Medicare and Medicaid Services, U.S., Medicare Part C, ACC Advocacy

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