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HHS-Developed Risk Adjustment Model Algorithm Instructions (PDF)
Centers for Medicare & Medicaid Services [CMS], U.S. Department of Health and Human Services [HHS]
[Official Guidance] May 7, 2013
"This document provides instructions for the HHS risk adjustment models for the 2014 benefit year. The risk adjustment methodology consists of concurrent risk adjustment models, one for each combination of metal level (platinum, gold, silver, bronze, and catastrophic) and age group (adult, child, infant). This document provides the detailed information needed to calculate risk scores given individual diagnoses. The model instructions are based on the methodology described in the final notice of benefit and payment parameters." [Technical details (XLSX) are at http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/ra_tables_04_16_2013xlsx.xlsx -- Also, an SAAS Version of Software (ZIP) is available at http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/ra-sas-software.zip]
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