Table 1-4.,,,,, CMS-HCC Community and Institutional Models for Functioning Graft1,,,,, ,,,,, Additional payment factors for functioning graft status are at bottom of table.,,,,, Variable,Disease Group,Community Relative Factor,Constraints2,Institutional Relative Factor,Constraints2 Age/Sex Groups,,,,, Female,,,,, 0-34 Years,,0.223,,1.240, 35-44 Years ,,0.224,,0.879, 45-54 Years ,,0.304,,0.879, 55-59 Years ,,0.370,,0.879, 60-64 Years ,,0.422,,0.879, 65-69 Years ,,0.298,,0.945, 70-74 Years ,,0.371,,0.885, 75-79 Years ,,0.468,,0.822, 80-84 Years ,,0.546,,0.757, 85-89 Years ,,0.637,,0.694, 90-94 Years ,,0.788,,0.617, 95 Years or Over ,,0.783,,0.482, ,,,,, Male,,,,, 0-34 Years ,,0.107,,1.059, 35-44 Years ,,0.167,,0.822, 45-54 Years ,,0.197,,0.842, 55-59 Years ,,0.297,,0.916, 60-64 Years ,,0.401,,0.970, 65-69 Years ,,0.330,,1.140, 70-74 Years ,,0.416,,1.093, 75-79 Years ,,0.520,,1.093, 80-84 Years ,,0.617,,1.056, 85-89 Years ,,0.744,,1.033, 90-94 Years ,,0.830,,0.895, 95 Years or Over ,,0.960,,0.775, ,,,,, Medicaid and Originally Disabled Interactions With Age and Sex5,,,,, Medicaid_Female_Disabled,,0.137,,0.000, Medicaid_Female_Aged,,0.177,,0.000, Medicaid_Male_Disabled,,0.090,,0.000, Medicaid_Male_Aged,,0.202,,0.000, "Female, 65+, originally entitled due to disability",,0.232,,0.000, "Male, 65+, originally entitled due to disability",,0.181,,0.000, ,,,,, 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, 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 Manifestation,0.608,,0.466, HCC16,Diabetes with Neurologic or Other Specified Manifestation,0.452,,0.466, HCC17,Diabetes with Acute Complications,0.364,,0.466, HCC18,Diabetes with Ophthalmologic or Unspecified Manifestation,0.265,,0.466, HCC19,Diabetes without Complication,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, HCC75,"Coma, Brain Compression/Anoxic Damage",0.446,C1,0.000, 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 Status3,0.000,,0.000, HCC131,Renal Failure3,0.000,,0.000, 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,C1,0.000, 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, HCC161,Traumatic Amputation,0.736,,0.224,C1 HCC164,Major Complications of Medical Care and Trauma,0.299,,0.219, HCC174,Major Organ Transplant Status,0.362,,0.362, HCC176,Artificial Openings for Feeding or Elimination,0.758,,0.843, HCC177,"Amputation Status, Lower Limb/Amputation Complications",0.653,,0.224,C1 ,,,,, 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_CHF4,0.204,,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_CHF4,0.248,,0.000, INT6,RF_CHF_DM4,0.664,,0.203, ,,,,, Graft Factors6,,,,, "Aged <65, with duration since transplant of 4-9 months",,3.391,,3.391, "Aged 65+, with duration since transplant of 4-9 months",,3.391,,3.391, "Aged <65, with duration since transplant of 10 months or more",,1.152,,1.152, "Aged 65+, with duration since transplant of 10 months or more",,1.323,,1.323, ,,,,, "1To determine payments for persons with functioning grafts, the computed risk score should be applied to the appropriate cell in the CMS-HCC county risk ratebook for the aged and disabled. For payment in any month, duration is measured from the month of transplant to the first day of that month. All coefficients except for the graft factors and HCC174 were constrained to the values estimates for the 2003 Calibration CMS-HCC Aged-Disabled Community Model.",,,,, ,,,,, ,,,,, ,,,,, "2_______ means coefficients of HCCs are constrained to be equal, and C1 denotes a non-continguous constraint. For the community model C1=.446; for the institutional model C1=.224.",,,,, ,,,,, 3Kidney failure and Dialysis status HCCs are not captured in the model for functioning graft beneficiaries. The cost of treating their transplanted kidney is captured instead in the post-graft factors. Should a post-graft patient have failure again they would return to dialysis status and be paid under the dialysis model.,,,,, 4Diseases in interactions are: ,,,,, 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)",,,,, RF is renal failure (HCC 131),,,,, "Beneficiaries 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. A beneficiary with all three conditions is not ""credited"" with the two-way interactions. All other interaction terms are additive. ",,,,, ,,,,, ,,,,, ,,,,, 5These HCCs are not present in the institutional model.,,,,, "6The graft factors are additive, similar to any other factors in the CMS-HCC model. The factor is higher during the months immediately after transplant to account for a high level of monitoring and services.",,,,, ,,,,,