"ENCLOSURE IV: CMS-HCC Risk Adjustment Factors
EXHIBIT 1.  Community and Institutional Factors for CMS-HCC 70 Model",,,,,
,EXHIBIT 1.  Community and Institutional Factors for CMS-HCC 70 Model,,,,
Variable,Disease Group,Community Factors,Institutional Factors,,
Age/Sex Factors,,,,,
Female 0-34 Years,,0.223,1.240,,
Female 35-44 Years,,0.224,0.879,,
Female 45-54 Years,,0.304,0.879,,
Female 55-59 Years,,0.370,0.879,,
Female 60-64 Years,,0.422,0.879,,
Female 65-69 Years,,0.298,0.945,,
Female 70-74 Years,,0.371,0.885,,
Females 75-79 Years,,0.468,0.822,,
Female 80-84 Years,,0.546,0.757,,
Female 85-89 Years,,0.637,0.694,,
Female 90-94 Years,,0.788,0.617,,
Female 95 Years or Over,,0.783,0.482,,
Male 0-34 Years,,0.107,1.059,,
Male 35-44 Years,,0.167,0.822,,
Male 45-54 Years,,0.197,0.842,,
Male 55-59 Years,,0.297,0.916,,
Male 60-64 Years,,0.401,0.970,,
Male 65-69 Years,,0.330,1.140,,
Male 70-74 Years,,0.416,1.093,,
Male 75-79 Years,,0.520,1.093,,
Male 80-84 Years,,0.617,1.056,,
Male 85-89 Years,,0.744,1.033,,
Male 90-94 Years,,0.830,0.895,,
Male 95 Years or Over,,0.960,0.775,,
Medicaid & Originally Disabled Interactions with Age & Sex,,,,,
"Medicaid Female, Disabled",,0.137,0.077,,
"Medicaid Female, Aged",,0.177,0.077,,
"Medicaid Male, Disabled",,0.090,0.077,,
"Medicaid Male, Aged",,0.202,0.077,,
"Originally-Disabled, Female",,0.232,0.019,,
"Originally-Disabled, Male",,0.181,0.019,,
Disease Group Factors,,,,,
HCC1,HIV/AIDS,0.933,0.735,,
HCC2,Septicemia/Shock,0.887,0.762,,
HCC5,Opportunistic Infections,0.410,0.476,,
HCC7,Metastatic Cancer and Acute Leukemia,1.648,0.568,,
HCC8,"Lung, Upper Digestive Tract, and Other Severe Cancers",1.648,0.568,,
Variable,Disease Group,Community Factors,Institutional Factors,,
HCC9,"Lymphatic, Head and Neck, Brain, and Other Major Cancers",0.771,0.402,,
HCC10,"Breast, Prostate, Colorectal and Other Cancers and Tumors",0.258,0.241,,
HCC15,Diabetes with Renal or Peripheral Circulatory Manifestation1,0.608,0.466,,
HCC16,Diabetes with Neurologic or Other Specified Manifestation1,0.452,0.466,,
HCC17,Diabetes with Acute Complications1,0.364,0.466,,
HCC18,Diabetes with Ophthalmologic or Unspecified Manifestation1,0.265,0.466,,
HCC19,Diabetes without Complication1,0.181,0.257,,
HCC21,Protein-Calorie Malnutrition,0.820,0.395,,
HCC25,End-Stage Liver Disease,0.996,0.768,,
HCC26,Cirrhosis of Liver,0.519,0.363,,
HCC27,Chronic Hepatitis,0.303,0.363,,
HCC31,Intestinal Obstruction/Perforation,0.347,0.349,,
HCC32,Pancreatic Disease,0.383,0.277,,
HCC33,Inflammatory Bowel Disease,0.270,0.263,,
HCC37,Bone/Joint/Muscle Infections/Necrosis,0.550,0.482,,
HCC38,Rheumatoid Arthritis and Inflammatory Connective Tissue Disease,0.363,0.233,,
HCC44,Severe Hematological Disorders,1.136,0.477,,
HCC45,Disorders of Immunity,0.841,0.443,,
HCC51,Drug/Alcohol Psychosis,0.250,0.000,,
HCC52,Drug/Alcohol Dependence,0.250,0.000,,
HCC54,Schizophrenia,0.515,0.347,,
HCC55,"Major Depressive, Bipolar, and Paranoid Disorders",0.370,0.308,,
HCC67,"Quadriplegia, Other Extensive Paralysis",0.961,0.337,,
HCC68,Paraplegia,0.961,0.291,,
HCC69,Spinal Cord Disorders/Injuries,0.511,0.152,,
HCC70,Muscular Dystrophy,0.466,0.000,,
HCC71,Polyneuropathy,0.324,0.253,,
HCC72,Multiple Sclerosis,0.472,0.174,,
HCC73,Parkinson's and Huntington's Diseases,0.547,0.089,,
HCC74,Seizure Disorders and Convulsions,0.280,0.165,,
Variable,Disease Group,Community Factors,Institutional Factors,,
HCC75,"Coma, Brain Compression/Anoxic Damage",0.446,0.000,,
HCC77,Respirator Dependence/Tracheostomy Status,1.860,1.360,,
HCC78,Respiratory Arrest,1.448,0.984,,
HCC79,Cardio-Respiratory Failure and Shock,0.629,0.464,,
HCC80,Congestive Heart Failure,0.395,0.231,,
HCC81,Acute Myocardial Infarction,0.349,0.474,,
HCC82,Unstable Angina and Other Acute Ischemic Heart Disease,0.332,0.474,,
HCC83,Angina Pectoris/Old Myocardial Infarction,0.231,0.296,,
HCC92,Specified Heart Arrhythmias,0.295,0.198,,
HCC95,Cerebral Hemorrhage,0.366,0.175,,
HCC96,Ischemic or Unspecified Stroke,0.303,0.175,,
HCC100,Hemiplegia/Hemiparesis,0.410,0.065,,
HCC101,Cerebral Palsy and Other Paralytic Syndromes,0.212,0.000,,
HCC104,Vascular Disease with Complications,0.645,0.495,,
HCC105,Vascular Disease,0.324,0.164,,
HCC107,Cystic Fibrosis,0.398,0.327,,
HCC108,Chronic Obstructive Pulmonary Disease,0.398,0.327,,
HCC111,Aspiration and Specified Bacterial Pneumonias,0.761,0.644,,
HCC112,"Pneumococcal Pneumonia, Emphysema, Lung Abscess",0.233,0.188,,
HCC119,Proliferative Diabetic Retinopathy and Vitreous Hemorrhage,0.278,0.527,,
HCC130,Dialysis Status,1.432,2.211,,
HCC131,Renal Failure,0.389,0.411,,
HCC132,Nephritis,0.182,0.290,,
HCC148,Decubitus Ulcer of Skin,1.167,0.474,,
HCC149,"Chronic Ulcer of Skin, Except Decubitus",0.463,0.239,,
HCC150,Extensive Third-Degree Burns,0.818,0.000,,
HCC154,Severe Head Injury,0.446,0.000,,
HCC155,Major Head Injury,0.182,0.000,,
HCC157,Vertebral Fractures without Spinal Cord Injury,0.501,0.109,,
HCC158,Hip Fracture/Dislocation,0.450,0.000,,
Variable,Disease Group,Community Factors,Institutional Factors,,
HCC161,Traumatic Amputation,0.736,0.224,,
HCC164,Major Complications of Medical Care and Trauma,0.299,0.219,,
HCC174,Major Organ Transplant Status,1.073,0.449,,
HCC176,Artificial Openings for Feeding or Elimination,0.758,0.843,,
HCC177,"Amputation Status, Lower Limb/Amputation Complications",0.653,0.224,,
Disabled/Disease Interactions,,,,,
D-HCC5,Disabled*Opportunistic Infections,0.941,0.280,,
D-HCC44,Disabled*Severe Hematological Disorders,0.551,0.419,,
D-HCC51,Disabled*Drug/Alcohol Psychosis ,0.801,0.425,,
D-HCC52,Disabled*Drug/Alcohol Dependence,0.356,0.425,,
D-HCC107,Disabled*Cystic Fibrosis,1.391,0.000,,
Disease Interactions,,,,,
INT1,DM*CHF2,0.204,0.088,,
INT2,DM*CVD,0.149,0.026,,
INT3,CHF*COPD,0.216,0.194,,
INT4,COPD*CVD*CAD,0.174,0.042,,
INT5,RF*CHF2,0.248,0.000,,
INT6,RF*CHF*DM2,0.664,0.203,,

"Note:  The 2005 denominator of $6,496.03 was used to calculate both the community and institutional factors.",,,,,
,,,,,
1Includes Type I or Type II Diabetes Mellitus.,,,,,
"2Beneficiaries with the three-way interaction RF*CHF*DM are excluded from the two-way interactions DM*CHF and RF*CHF. Thus, the three-way interaction term RF*CHF*DM is not additive to the two-way interaction terms DM*CHF and RF*CHF.  Rather, it is hierarchical to, and excludes these interaction terms.  All other interaction terms are additive.",,,,,
,,,,,
DM is diabetes mellitus (HCCs 15-19).,,,
CHF is congestive heart failure (HCC 80).,,,
COPD is chronic obstructive pulmonary disease (HCC 108).,,,
"CVD is cerebrovascular disease (HCCs 95, 96, 100, and 101).",,,
CAD is coronary artery disease (HCCs 81-83).,,,
RF is renal failure (HCC 131).,,,
,,,
SOURCES:,,,
Community Factors: RTI International analysis of 2002/2003 Medicare 5% sample.,,,
Institutional Factors: RTI International analysis of 2002/2003 Medicare 100% institutional sample.,,,