Payments to Medicare+Choice Organizations409
The Secretary will adjust payment amounts to Medicare+Choice organizations for such risk factors as health status to ensure actuarial equivalence.410 For purposes of this adjustment and with respect to special needs individuals with chronic health conditions, the Secretary will use a risk score that reflects the known underlying risk profile and chronic health status of similar individuals.411 The Secretary will annually evaluate and revise this system in order to account for higher medical and care coordination costs associated with frailty, individuals with multiple, comorbid chronic conditions and individuals with a diagnosis of mental illness.412 The Secretary will require Medicare+Choice organizations to submit data regarding inpatient hospital services413 in order to develop a report on the method of risk adjustment of payment rates that accounts for variations in costs based on health status.414
Footnotes
- 409. Social Security Act § 1853, 42 U.S.C. 1395w-23.
- 410. Social Security Act §1853(a)(1)(C)(i), 42 U.S.C. 1395w-23(a)(1)(C)(i).
- 411. Social Security Act § 1853(a)(1)(C)(iii)(I), 42 U.S.C. 1395w-23(a)(1)(C)(iii)(I).
- 412. Social Security Act § 1853(a)(1)(C)(iii)(III), 42 U.S.C. 1395w-23(a)(1)(C)(iii)(III).
- 413. Social Security Act § 1853(a)(3)(B), 42 U.S.C. 1395w-23(a)(3)(B).
- 414. Social Security Act § 1853(a)(3)(A), 42 U.S.C. 1395w-23(a)(3)(A).
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