14. Department of Health and Human Services · Notable · Needs Congress
Reconfigure the Medicare Advantage risk adjustment model
Printed page 465 14. Department of Health and Human Services
“Reconfigure the current risk adjustment model.”
What has happened
- Not started
The risk adjustment model was not reconfigured. The CY 2027 Advance Notice proposes a 2027 CMS-HCC model with "the same segmentation structure" and "the same demographic variables and HCCs as the 2024 CMS-HCC risk adjustment model" — eight segments, condition-count variables, version 28 of the clinical classification — differing only in recalibration and in dropping one coefficient constraint on chronic kidney disease stages. That is the annual maintenance of the existing model, not the reconfiguration the Mandate asks Congress for; and no bill of the 119th Congress addresses MA risk adjustment.
Research log
What was searched, and what didn’t count as evidence
Research notes
- Searched: the titles of the bills we keep and search, for “risk adjustment” → 0. Federal Register “Risk Adjustment Data Validation” and “RADV” since 2025-01-20 → six and five documents, none a model change. The CY 2027 Advance Notice PDF was downloaded from cms.gov and Section G read in full.
- The last real reconfiguration, the V28 clinical classification, was phased in for CY 2024–2026 under the previous administration and is carried forward unchanged.
- The audit-side response to MA coding intensity is #1255 (RADV), which did move.
- Action
- other
- Object
- Medicare Advantage risk adjustment model
- ID
- 1264