Proposed Rule2026-04467
Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program; Correction
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Published
March 6, 2026
Effective
March 6, 2026
Issuing agencies
Health and Human Services DepartmentCenters for Medicare & Medicaid Services
Abstract
This document corrects technical errors in the proposed rule that appeared in the February 11, 2026, Federal Register titled "Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program."
Full Text
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<title>Federal Register, Volume 91 Issue 44 (Friday, March 6, 2026)</title>
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[Federal Register Volume 91, Number 44 (Friday, March 6, 2026)]
[Proposed Rules]
[Pages 11006-11017]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-04467]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 600
Office of the Secretary
45 CFR Parts 153, 154, 155, 156, and 158
[CMS-9883-CN]
RIN 0938-AV62
Patient Protection and Affordable Care Act, HHS Notice of Benefit
and Payment Parameters for 2027; and Basic Health Program; Correction
AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of
Health and Human Services (HHS).
[[Page 11007]]
ACTION: Proposed rule; correction.
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SUMMARY: This document corrects technical errors in the proposed rule
that appeared in the February 11, 2026, Federal Register titled
``Patient Protection and Affordable Care Act, HHS Notice of Benefit and
Payment Parameters for 2027; and Basic Health Program.''
DATES: This correction is effective March 6, 2026.
FOR FURTHER INFORMATION CONTACT:
Jeff Wu, (301) 492-4305, Rogelyn McLean, (410) 786-1524, Grace
Bristol, (410) 786-8437, for general information.
Ayesha Anwar, (301) 448-3625, or Joshua Paul, (301) 492-4347, for
matters related to the HHS-operated risk adjustment and risk adjustment
data validation (HHS-RADV) programs.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2026-02769 of February 11, 2026 (91 FR 6292), there were
a number of technical errors that are identified and corrected in this
correcting document.
II. Summary of Errors
On pages 6306 through 6319, we inadvertently omitted column
headings in Tables 1 through 7.
III. Correction of Errors
In FR Doc. 2026-02769 of February 11, 2026 (91 FR 6292), make the
following corrections:
1. On pages 6306 through 6312, the table titled ``TABLE 1: Proposed
Adult Risk Adjustment Model Factors for the 2027 Benefit Year'' is
corrected to read as follows:
Table 1--Proposed Adult Risk Adjustment Model Factors for the 2027 Benefit Year
----------------------------------------------------------------------------------------------------------------
HCC or RXC No. Factor Platinum Gold Silver Bronze Catastrophic
----------------------------------------------------------------------------------------------------------------
Demographic Factors
----------------------------------------------------------------------------------------------------------------
Age 21-24, Male...... 0.189 0.135 0.097 0.068 0.060
Age 25-29, Male...... 0.201 0.142 0.100 0.067 0.059
Age 30-34, Male...... 0.231 0.166 0.118 0.080 0.070
Age 35-39, Male...... 0.252 0.183 0.130 0.088 0.076
Age 40-44, Male...... 0.280 0.206 0.149 0.101 0.088
Age 45-49, Male...... 0.322 0.244 0.183 0.132 0.118
Age 50-54, Male...... 0.371 0.286 0.219 0.163 0.147
Age 55-59, Male...... 0.413 0.322 0.250 0.188 0.171
Age 60-64, Male...... 0.467 0.366 0.286 0.216 0.198
Age 21-24, Female.... 0.278 0.196 0.132 0.082 0.067
Age 25-29, Female.... 0.311 0.221 0.149 0.091 0.074
Age 30-34, Female.... 0.384 0.288 0.209 0.144 0.126
Age 35-39, Female.... 0.435 0.335 0.253 0.184 0.166
Age 40-44, Female.... 0.484 0.379 0.292 0.216 0.195
Age 45-49, Female.... 0.491 0.385 0.293 0.214 0.192
Age 50-54, Female.... 0.506 0.397 0.302 0.219 0.197
Age 55-59, Female.... 0.467 0.358 0.265 0.184 0.162
Age 60-64, Female.... 0.467 0.355 0.260 0.177 0.154
----------------------------------------------------------------------------------------------------------------
Diagnosis Factors
----------------------------------------------------------------------------------------------------------------
HCC001........................ HIV/AIDS............. 0.000 0.000 0.000 0.000 0.000
----------------------------------------------------------------------------------------------------------------
HCC002........................ Septicemia, Sepsis, 8.520 8.314 8.233 8.129 8.123
Systemic
Inflammatory
Response Syndrome/
Shock.
HCC003........................ Central Nervous 7.760 7.653 7.601 7.527 7.511
System Infections,
Except Viral
Meningitis.
HCC004........................ Viral or Unspecified 6.855 6.746 6.678 6.590 6.569
Meningitis.
HCC006........................ Opportunistic 8.110 8.053 7.995 7.916 7.892
Infections.
HCC008........................ Metastatic Cancer.... 22.129 21.703 21.654 21.525 21.533
HCC009........................ Lung, Brain, and 12.286 11.994 11.925 11.798 11.789
Other Severe
Cancers, Including
Pediatric Acute
Lymphoid Leukemia.
HCC010........................ Non-Hodgkin Lymphomas 5.400 5.216 5.126 5.002 4.980
and Other Cancers
and Tumors.
HCC011........................ Colorectal, Breast 3.851 3.657 3.554 3.419 3.396
(Age <50), Kidney,
and Other Cancers.
HCC012........................ Breast (Age 50+) and 2.465 2.326 2.237 2.127 2.105
Prostate Cancer,
Benign/Uncertain
Brain Tumors, and
Other Cancers and
Tumors.
HCC013........................ Thyroid Cancer, 1.025 0.930 0.825 0.710 0.681
Melanoma,
Neurofibromatosis,
and Other Cancers
and Tumors.
HCC018........................ Pancreas Transplant 5.506 5.552 5.642 5.734 5.757
Status.
HCC019........................ Diabetes with Acute 0.189 0.145 0.102 0.060 0.050
Complications.
HCC020........................ Diabetes with Chronic 0.189 0.145 0.102 0.060 0.050
Complications.
HCC021........................ Diabetes without 0.189 0.145 0.102 0.060 0.050
Complication.
HCC022........................ Type 1 Diabetes 0.179 0.155 0.111 0.045 0.023
Mellitus, add-on to
Diabetes HCCs 19-21.
HCC023........................ Protein-Calorie 10.099 9.974 9.925 9.854 9.843
Malnutrition.
HCC026........................ Mucopolysaccharidosis 18.785 18.604 18.567 18.498 18.495
HCC027........................ Lipidoses and 18.785 18.604 18.567 18.498 18.495
Glycogenosis.
HCC029........................ Amyloidosis, 5.455 5.353 5.299 5.229 5.216
Porphyria, and Other
Metabolic Disorders.
[[Page 11008]]
HCC030........................ Adrenal, Pituitary, 1.291 1.216 1.150 1.071 1.053
and Other
Significant
Endocrine Disorders.
HCC034........................ Liver Transplant 5.506 5.552 5.642 5.734 5.757
Status/Complications.
HCC035_1 \a\.................. Acute Liver Failure/ 6.880 6.693 6.630 6.548 6.543
Disease, Including
Neonatal Hepatitis.
HCC035_2...................... Chronic Liver Failure/ 2.234 2.070 2.000 1.906 1.896
End-Stage Liver
Disorders.
HCC036........................ Cirrhosis of Liver... 0.616 0.537 0.476 0.401 0.387
HCC037_1...................... Chronic Viral 0.516 0.455 0.396 0.336 0.325
Hepatitis C.
HCC037_2...................... Chronic Hepatitis, 0.516 0.455 0.396 0.336 0.325
Except Chronic Viral
Hepatitis C.
HCC041........................ Intestine Transplant 5.506 5.552 5.642 5.734 5.757
Status/Complications.
HCC042........................ Peritonitis/ 10.409 10.234 10.209 10.146 10.144
Gastrointestinal
Perforation/
Necrotizing
Enterocolitis.
HCC045........................ Intestinal 4.795 4.594 4.499 4.369 4.350
Obstruction.
HCC046........................ Chronic Pancreatitis. 2.131 1.971 1.875 1.755 1.738
HCC047........................ Acute Pancreatitis... 2.131 1.971 1.875 1.755 1.738
HCC048........................ Inflammatory Bowel 3.007 2.889 2.788 2.652 2.614
Disease.
HCC054........................ Necrotizing Fasciitis 6.731 6.567 6.536 6.475 6.470
HCC055........................ Bone/Joint/Muscle 4.138 3.961 3.912 3.843 3.843
Infections/Necrosis.
HCC056........................ Rheumatoid Arthritis 1.363 1.259 1.188 1.104 1.086
and Specified
Autoimmune Disorders.
HCC057........................ Systemic Lupus 0.355 0.286 0.198 0.098 0.069
Erythematosus and
Other Autoimmune
Disorders.
HCC061........................ Osteogenesis 1.753 1.635 1.546 1.437 1.415
Imperfecta and Other
Osteodystrophies.
HCC062........................ Congenital/ 1.753 1.635 1.546 1.437 1.415
Developmental
Skeletal and
Connective Tissue
Disorders.
HCC063........................ Cleft Lip/Cleft 0.823 0.732 0.640 0.542 0.520
Palate.
HCC066........................ Hemophilia........... 70.952 70.627 70.590 70.491 70.495
HCC067........................ Myelodysplastic 9.888 9.761 9.718 9.648 9.639
Syndromes and
Myelofibrosis.
HCC068........................ Aplastic Anemia...... 9.888 9.761 9.718 9.648 9.639
HCC069........................ Acquired Hemolytic 9.888 9.761 9.718 9.648 9.639
Anemia, Including
Hemolytic Disease of
Newborn.
HCC070........................ Sickle Cell Anemia 1.833 1.725 1.635 1.537 1.518
(Hb-SS) and
Thalassemia Beta
Zero.
HCC071........................ Sickle-Cell 1.457 1.397 1.348 1.292 1.279
Disorders, Except
Sickle-Cell Anemia
(Hb-SS) and
Thalassemia Beta
Zero; Beta
Thalassemia Major.
HCC073........................ Combined and Other 4.364 4.272 4.239 4.184 4.176
Severe
Immunodeficiencies.
HCC074........................ Disorders of the 4.364 4.272 4.239 4.184 4.176
Immune Mechanism.
HCC075........................ Coagulation Defects 2.167 2.085 2.024 1.948 1.930
and Other Specified
Hematological
Disorders.
HCC081........................ Drug Use with 1.479 1.349 1.232 1.092 1.059
Psychotic
Complications.
HCC082........................ Drug Use Disorder, 1.479 1.349 1.232 1.092 1.059
Moderate/Severe, or
Drug Use with Non-
Psychotic
Complications.
HCC083........................ Alcohol Use with 0.857 0.746 0.647 0.533 0.507
Psychotic
Complications.
HCC084........................ Alcohol Use Disorder, 0.857 0.746 0.647 0.533 0.507
Moderate/Severe, or
Alcohol Use with
Specified Non-
Psychotic
Complications.
HCC087_1...................... Schizophrenia........ 2.215 2.050 1.928 1.784 1.757
HCC087_2...................... Delusional and Other 2.087 1.932 1.803 1.645 1.611
Specified Psychotic
Disorders,
Unspecified
Psychosis.
HCC088........................ Major Depressive 0.927 0.831 0.728 0.609 0.578
Disorder, Severe,
and Bipolar
Disorders.
HCC090........................ Personality Disorders 0.666 0.587 0.487 0.377 0.343
HCC094........................ Anorexia/Bulimia 1.855 1.749 1.663 1.555 1.529
Nervosa.
HCC096........................ Prader-Willi, Patau, 9.243 9.207 9.184 9.155 9.144
Edwards, and
Autosomal Deletion
Syndromes.
HCC097........................ Down Syndrome, 0.779 0.715 0.659 0.596 0.581
Fragile X, Other
Chromosomal
Anomalies, and
Congenital
Malformation
Syndromes.
HCC102........................ Autistic Disorder.... 0.670 0.590 0.496 0.397 0.367
HCC103........................ Pervasive 0.666 0.587 0.487 0.377 0.343
Developmental
Disorders, Except
Autistic Disorder.
HCC106........................ Traumatic Complete 9.567 9.405 9.331 9.227 9.211
Lesion Cervical
Spinal Cord.
HCC107........................ Quadriplegia......... 9.567 9.405 9.331 9.227 9.211
HCC108........................ Traumatic Complete 6.337 6.186 6.106 5.994 5.975
Lesion Dorsal Spinal
Cord.
HCC109........................ Paraplegia........... 6.337 6.186 6.106 5.994 5.975
HCC110........................ Spinal Cord Disorders/ 4.665 4.482 4.406 4.296 4.280
Injuries.
HCC111........................ Amyotrophic Lateral 6.067 5.909 5.822 5.707 5.686
Sclerosis and Other
Anterior Horn Cell
Disease.
HCC112........................ Quadriplegic Cerebral 0.975 0.868 0.773 0.658 0.631
Palsy.
HCC113........................ Cerebral Palsy, 0.426 0.363 0.300 0.229 0.210
Except Quadriplegic.
[[Page 11009]]
HCC114........................ Spina Bifida and 1.116 1.035 0.959 0.864 0.841
Other Brain/Spinal/
Nervous System
Congenital Anomalies.
HCC115........................ Myasthenia Gravis/ 4.927 4.844 4.822 4.783 4.779
Myoneural Disorders
and Guillain-Barre
Syndrome/
Inflammatory and
Toxic Neuropathy.
HCC117........................ Muscular Dystrophy... 1.362 1.272 1.191 1.094 1.070
HCC118........................ Multiple Sclerosis... 2.461 2.331 2.253 2.151 2.131
HCC119........................ Parkinson's, 1.362 1.272 1.191 1.094 1.070
Huntington's, and
Spinocerebellar
Disease, and Other
Neurodegenerative
Disorders.
HCC120........................ Seizure Disorders and 0.929 0.840 0.758 0.660 0.637
Convulsions.
HCC121........................ Hydrocephalus........ 8.919 8.823 8.773 8.704 8.689
HCC122........................ Nontraumatic Coma, 9.620 9.477 9.417 9.325 9.307
Except Diabetic,
Hepatic, or
Hypoglycemic;
Nontraumatic Brain
Compression/Anoxic
Damage.
HCC123........................ Narcolepsy and 4.303 4.171 4.101 4.006 3.987
Cataplexy.
HCC125........................ Respirator Dependence/ 20.117 19.902 19.845 19.752 19.744
Tracheostomy Status.
HCC126........................ Respiratory Arrest... 7.858 7.659 7.579 7.478 7.472
HCC127........................ Cardio-Respiratory 7.858 7.659 7.579 7.478 7.472
Failure and Shock,
Including
Respiratory Distress
Syndromes.
HCC128........................ Heart Assistive 14.408 14.322 14.312 14.307 14.304
Device/Artificial
Heart.
HCC129........................ Heart Transplant 14.408 14.322 14.312 14.307 14.304
Status/Complications.
HCC130........................ Heart Failure........ 1.628 1.543 1.490 1.421 1.407
HCC131........................ Acute Myocardial 4.410 4.188 4.129 4.044 4.047
Infarction.
HCC132........................ Unstable Angina and 3.261 3.073 2.986 2.868 2.856
Other Acute Ischemic
Heart Disease.
HCC135........................ Heart Infection/ 7.943 7.850 7.792 7.709 7.689
Inflammation, Except
Rheumatic.
HCC137........................ Hypoplastic Left 2.004 1.911 1.843 1.763 1.745
Heart Syndrome and
Other Severe
Congenital Heart
Disorders.
HCC138........................ Major Congenital 2.004 1.911 1.843 1.763 1.745
Heart/Circulatory
Disorders.
HCC139........................ Atrial and 2.004 1.911 1.843 1.763 1.745
Ventricular Septal
Defects, Patent
Ductus Arteriosus,
and Other Congenital
Heart/Circulatory
Disorders.
HCC142........................ Specified Heart 1.831 1.725 1.640 1.531 1.501
Arrhythmias.
HCC145........................ Intracranial 9.782 9.608 9.545 9.452 9.441
Hemorrhage.
HCC146........................ Ischemic or 1.438 1.326 1.258 1.173 1.161
Unspecified Stroke.
HCC149........................ Cerebral Aneurysm and 1.977 1.859 1.772 1.659 1.634
Arteriovenous
Malformation.
HCC150........................ Hemiplegia/ 2.618 2.497 2.459 2.405 2.403
Hemiparesis.
HCC151........................ Monoplegia, Other 2.198 2.088 2.019 1.931 1.916
Paralytic Syndromes.
HCC153........................ Atherosclerosis of 7.585 7.409 7.407 7.376 7.389
the Extremities with
Ulceration or
Gangrene.
HCC154........................ Vascular Disease with 4.906 4.756 4.694 4.605 4.591
Complications.
HCC156........................ Pulmonary Embolism 7.104 7.018 6.942 6.837 6.805
and Deep Vein
Thrombosis.
HCC158........................ Lung Transplant 11.333 11.261 11.238 11.227 11.221
Status/Complications.
HCC159........................ Cystic Fibrosis...... 2.992 2.873 2.799 2.714 2.700
HCC160........................ Chronic Obstructive 0.615 0.539 0.454 0.360 0.334
Pulmonary Disease,
Including
Bronchiectasis.
HCC161_1...................... Severe Asthma........ 0.615 0.539 0.454 0.360 0.334
HCC161_2...................... Asthma, Except Severe 0.615 0.539 0.454 0.360 0.334
HCC162........................ Fibrosis of Lung and 1.305 1.231 1.161 1.075 1.052
Other Lung Disorders.
HCC163........................ Aspiration and 6.880 6.765 6.706 6.629 6.616
Specified Bacterial
Pneumonias and Other
Severe Lung
Infections.
HCC174........................ Exudative Macular 1.231 1.115 0.988 0.838 0.804
Degeneration.
HCC183........................ Kidney Transplant 5.506 5.552 5.642 5.734 5.757
Status/Complications.
HCC184........................ End Stage Renal 17.965 17.541 17.668 17.485 17.544
Disease.
HCC187........................ Chronic Kidney 0.749 0.679 0.661 0.621 0.622
Disease, Stage 5.
HCC188........................ Chronic Kidney 0.749 0.679 0.661 0.621 0.622
Disease, Severe
(Stage 4).
HCC203........................ Ectopic and Molar 1.438 1.302 1.131 0.927 0.875
Pregnancy.
HCC204........................ Miscarriage with 0.638 0.554 0.420 0.253 0.193
Complications.
HCC205........................ Miscarriage with No 0.638 0.554 0.420 0.253 0.193
or Minor
Complications.
HCC207........................ Pregnancy with 3.610 3.349 3.031 2.654 2.581
Delivery with Major
Complications.
HCC208........................ Pregnancy with 3.610 3.349 3.031 2.654 2.581
Delivery with
Complications.
HCC209........................ Pregnancy with 2.645 2.446 2.126 1.713 1.597
Delivery with No or
Minor Complications.
HCC210........................ (Ongoing) Pregnancy 0.668 0.572 0.416 0.240 0.186
without Delivery
with Major
Complications.
HCC211........................ (Ongoing) Pregnancy 0.494 0.412 0.283 0.148 0.106
without Delivery
with Complications.
HCC212........................ (Ongoing) Pregnancy 0.023 0.000 0.000 0.000 0.000
without Delivery
with No or Minor
Complications.
HCC217........................ Chronic Ulcer of 1.351 1.259 1.205 1.140 1.131
Skin, Except
Pressure.
HCC218........................ Extensive Third 28.529 28.296 28.253 28.168 28.162
Degree Burns.
[[Page 11010]]
HCC219........................ Major Skin Burn or 2.661 2.532 2.452 2.356 2.337
Condition.
HCC223........................ Severe Head Injury... 16.085 15.926 15.853 15.744 15.724
HCC226........................ Hip and Pelvic 7.742 7.485 7.431 7.338 7.340
Fractures.
HCC228........................ Vertebral Fractures 4.007 3.844 3.742 3.608 3.582
without Spinal Cord
Injury.
HCC234........................ Traumatic Amputations 4.272 4.112 4.068 3.998 3.995
and Amputation
Complications.
HCC251........................ Stem Cell, Including 17.990 18.025 18.043 18.074 18.067
Bone Marrow,
Transplant Status/
Complications.
HCC253........................ Artificial Openings 5.400 5.276 5.237 5.177 5.172
for Feeding or
Elimination.
HCC254........................ Amputation Status, 0.923 0.828 0.775 0.708 0.699
Upper Limb or Lower
Limb.
----------------------------------------------------------------------------------------------------------------
Interacted HCC Counts Factors
----------------------------------------------------------------------------------------------------------------
Severe illness, 1 -5.506 -5.552 -5.642 -5.734 -5.757
payment HCC.
Severe illness, 2 -5.381 -5.451 -5.529 -5.615 -5.630
payment HCCs.
Severe illness, 3 -4.624 -4.683 -4.671 -4.664 -4.645
payment HCCs.
Severe illness, 4 -4.046 -4.060 -3.933 -3.798 -3.740
payment HCCs.
Severe illness, 5 -3.634 -3.590 -3.359 -3.113 -3.027
payment HCCs.
Severe illness, 6 -3.188 -3.063 -2.734 -2.385 -2.275
payment HCCs.
Severe illness, 7 -2.710 -2.475 -2.060 -1.614 -1.485
payment HCCs.
Severe illness, 8 -2.359 -2.047 -1.553 -1.014 -0.870
payment HCCs.
Severe illness, 9 -0.965 -0.515 0.053 0.682 0.839
payment HCCs.
Severe illness, 10 or 4.976 5.806 6.546 7.415 7.608
more payment HCCs.
Transplant severe 3.531 3.394 3.262 3.071 3.034
illness, 4 payment
HCCs.
Transplant severe 6.812 6.664 6.540 6.354 6.326
illness, 5 payment
HCCs.
Transplant severe 10.112 9.960 9.839 9.656 9.631
illness, 6 payment
HCCs.
Transplant severe 15.321 15.165 15.051 14.879 14.859
illness, 7 payment
HCCs.
Transplant severe 29.664 29.601 29.511 29.375 29.357
illness, 8 or more
payment HCCs.
----------------------------------------------------------------------------------------------------------------
Enrollment Duration Factors
----------------------------------------------------------------------------------------------------------------
Enrolled for 1 month, 11.074 9.697 8.663 7.661 7.414
at least one payment
HCC.
Enrolled for 2 4.976 4.271 3.729 3.226 3.102
months, at least one
payment HCC.
Enrolled for 3 3.206 2.743 2.369 2.026 1.944
months, at least one
payment HCC.
Enrolled for 4 1.883 1.566 1.297 1.054 0.995
months, at least one
payment HCC.
Enrolled for 5 1.400 1.164 0.955 0.763 0.714
months, at least one
payment HCC.
Enrolled for 6 0.936 0.762 0.599 0.448 0.407
months, at least one
payment HCC.
----------------------------------------------------------------------------------------------------------------
Affiliated Cost Factors
----------------------------------------------------------------------------------------------------------------
ACF01......................... HIV Pre-Exposure 3.620 3.551 3.472 3.304 3.258
Prophylaxis (PrEP).
----------------------------------------------------------------------------------------------------------------
Prescription Drug Factors
----------------------------------------------------------------------------------------------------------------
RXC01......................... Anti-HIV Agents...... 4.595 4.125 3.714 3.356 3.280
RXC02......................... Anti-Hepatitis C 9.107 8.614 8.476 8.335 8.361
(HCV) Agents, Direct
Acting Agents.
RXC03 \b\..................... Antiarrhythmics...... 0.058 0.052 0.046 0.039 0.046
RXC04......................... Phosphate Binders.... 0.868 0.993 0.785 0.988 0.917
RXC05......................... Inflammatory Bowel 1.133 1.100 1.040 0.981 0.962
Disease Agents.
RXC06......................... Insulin.............. 1.313 1.147 0.991 0.843 0.805
RXC07......................... Anti-Diabetic Agents, 0.973 0.862 0.698 0.485 0.419
Except Insulin and
Metformin Only.
RXC08......................... Multiple Sclerosis 12.472 11.759 11.490 11.110 11.042
Agents.
RXC09......................... Immune Suppressants 11.545 10.994 10.921 10.759 10.777
and Immunomodulators.
RXC10......................... Cystic Fibrosis 22.801 22.295 22.221 22.083 22.098
Agents.
RXC01 x HCC001................ Additional effect for 2.629 2.556 2.848 3.009 3.091
enrollees with RXC
01 and HCC 001.
RXC02 x HCC037_1, 036, 035_2, Additional effect for -0.516 -0.455 -0.396 -0.336 -0.325
035_1, 034. enrollees with RXC
02 and (HCC 037_1 or
036 or 035_2 or
035_1 or 034).
RXC03 x HCC142................ Additional effect for 0.000 0.000 0.000 0.000 0.000
enrollees with RXC
03 and HCC 142.
RXC04 x HCC184, 183, 187, 188. Additional effect for 0.000 0.000 0.000 0.000 0.000
enrollees with RXC
04 and (HCC 184 or
183 or 187 or 188).
RXC05 x HCC048, 041........... Additional effect for -1.106 -1.087 -1.040 -0.981 -0.962
enrollees with RXC
05 and (HCC 048 or
041).
RXC06 x HCC018, 019, 020, 021. Additional effect for 0.466 0.511 0.522 0.482 0.474
enrollees with RXC
06 and (HCC 018 or
019 or 020 or 021).
RXC07 x HCC018, 019, 020, 021. Additional effect for -0.187 -0.143 -0.102 -0.060 -0.050
enrollees with RXC
07 and (HCC 018 or
019 or 020 or 021).
RXC08 x HCC118................ Additional effect for -0.156 0.110 0.411 0.745 0.854
enrollees with RXC
08 and HCC 118.
[[Page 11011]]
RXC09 x HCC056 or 057 and 048 Additional effect for 0.492 0.557 0.646 0.751 0.780
or 041. enrollees with RXC
09 and (HCC 048 or
041) and (HCC 056 or
057).
RXC09 x HCC056................ Additional effect for -1.363 -1.259 -1.188 -1.104 -1.086
enrollees with RXC
09 and HCC 056.
RXC09 x HCC057................ Additional effect for -0.355 -0.286 -0.198 -0.098 -0.069
enrollees with RXC
09 and HCC 057.
RXC09 x HCC048, 041........... Additional effect for -1.901 -1.802 -1.748 -1.670 -1.651
enrollees with RXC
09 and (HCC 048 or
041).
RXC10 x HCC159, 158........... Additional effect for 36.448 36.460 36.625 36.751 36.785
enrollees with RXC
10 and (HCC 159 or
158).
----------------------------------------------------------------------------------------------------------------
\a\ HCC numbers that appear with an underscore in this document will appear without the underscore in the ``Do
It Yourself (DIY)'' software. For example, HCC 35_1 in this table will appear as HCC 351 in the DIY software.
\b\ We constrain RXC 03 to be equal to average plan liability for RXC 03 drugs, RXC 04 to be equal to the
average plan liability for RXC 04 drugs, and we constrain RXC 03 x HCC142 and RXC 04 x HCC184, 183, 187, 188
to be equal to zero. See March 2016 Risk Adjustment Methodology Discussion Paper (2016 March, 16), available
at: <a href="https://www.cms.gov/cciio/resources/forms-reports-and-other-resources/downloads/ra-march-31-white-paper-032416.pdf">https://www.cms.gov/cciio/resources/forms-reports-and-other-resources/downloads/ra-march-31-white-paper-032416.pdf</a> (where we previously discussed the use of constraints in the HHS risk adjustment models).
2. On pages 6313 through 6316, the table titled ``TABLE 2: Proposed
Child Risk Adjustment Model Factors for the 2027 Benefit Year'' is
corrected to read as follows:
Table 2--Proposed Child Risk Adjustment Model Factors for the 2027 Benefit Year
----------------------------------------------------------------------------------------------------------------
Factor Platinum Gold Silver Bronze Catastrophic
----------------------------------------------------------------------------------------------------------------
Demographic Factors
----------------------------------------------------------------------------------------------------------------
Age 2-4, Male..................................... 0.297 0.217 0.162 0.118 0.106
Age 5-9, Male..................................... 0.222 0.154 0.113 0.085 0.077
Age 10-14, Male................................... 0.210 0.146 0.108 0.082 0.076
Age 15-20, Male................................... 0.246 0.179 0.132 0.097 0.088
Age 2-4, Female................................... 0.237 0.166 0.124 0.092 0.084
Age 5-9, Female................................... 0.162 0.102 0.067 0.044 0.039
Age 10-14, Female................................. 0.216 0.153 0.115 0.089 0.082
Age 15-20, Female................................. 0.267 0.187 0.124 0.077 0.063
----------------------------------------------------------------------------------------------------------------
Diagnosis Factors
----------------------------------------------------------------------------------------------------------------
HIV/AIDS.......................................... 4.494 4.068 3.903 3.679 3.658
Septicemia, Sepsis, Systemic Inflammatory Response 14.480 14.282 14.169 14.032 14.013
Syndrome/Shock...................................
Central Nervous System Infections, Except Viral 14.430 14.273 14.207 14.113 14.097
Meningitis.......................................
Viral or Unspecified Meningitis................... 12.991 12.869 12.785 12.679 12.655
Opportunistic Infections.......................... 20.233 20.191 20.119 20.039 20.013
Metastatic Cancer................................. 31.479 31.228 31.163 31.056 31.045
Lung, Brain, and Other Severe Cancers, Including 9.613 9.381 9.254 9.091 9.059
Pediatric Acute Lymphoid Leukemia................
Non-Hodgkin Lymphomas and Other Cancers and Tumors 8.609 8.408 8.278 8.118 8.083
Colorectal, Breast (Age <50), Kidney, and Other 3.753 3.604 3.500 3.366 3.332
Cancers..........................................
Breast (Age 50+) and Prostate Cancer, Benign/ 3.753 3.604 3.500 3.366 3.332
Uncertain Brain Tumors, and Other Cancers and
Tumors...........................................
Thyroid Cancer, Melanoma, Neurofibromatosis, and 1.204 1.092 0.978 0.855 0.818
Other Cancers and Tumors.........................
Pancreas Transplant Status........................ 11.308 11.349 11.403 11.462 11.475
Diabetes with Acute Complications................. 2.107 1.904 1.613 1.264 1.175
Diabetes with Chronic Complications............... 2.107 1.904 1.613 1.264 1.175
Diabetes without Complication..................... 2.107 1.904 1.613 1.264 1.175
Protein-Calorie Malnutrition...................... 17.913 17.788 17.745 17.685 17.674
Mucopolysaccharidosis............................. 27.455 27.228 27.158 27.051 27.042
Lipidoses and Glycogenosis........................ 27.455 27.228 27.158 27.051 27.042
Congenital Metabolic Disorders, Not Elsewhere 4.860 4.741 4.671 4.584 4.566
Classified.......................................
Amyloidosis, Porphyria, and Other Metabolic 4.860 4.741 4.671 4.584 4.566
Disorders........................................
Adrenal, Pituitary, and Other Significant 4.585 4.353 4.263 4.148 4.135
Endocrine Disorders..............................
Liver Transplant Status/Complications............. 11.308 11.349 11.403 11.462 11.475
Acute Liver Failure/Disease, Including Neonatal 12.753 12.612 12.564 12.499 12.492
Hepatitis........................................
Chronic Liver Failure/End-Stage Liver Disorders... 8.744 8.588 8.509 8.401 8.379
Cirrhosis of Liver................................ 2.077 1.972 1.888 1.798 1.778
Chronic Viral Hepatitis C......................... 2.077 1.972 1.888 1.798 1.778
Chronic Hepatitis, Except Chronic Viral Hepatitis 1.367 1.287 1.195 1.098 1.073
C................................................
Intestine Transplant Status/Complications......... 15.155 15.082 15.015 14.930 14.907
Peritonitis/Gastrointestinal Perforation/ 17.893 17.607 17.538 17.427 17.422
Necrotizing Enterocolitis........................
Intestinal Obstruction............................ 3.920 3.746 3.616 3.458 3.423
[[Page 11012]]
Chronic Pancreatitis.............................. 9.814 9.635 9.554 9.449 9.434
Acute Pancreatitis................................ 6.643 6.415 6.272 6.089 6.054
Inflammatory Bowel Disease........................ 10.636 10.225 10.089 9.880 9.859
Necrotizing Fasciitis............................. 4.686 4.490 4.367 4.224 4.197
Bone/Joint/Muscle Infections/Necrosis............. 4.686 4.490 4.367 4.224 4.197
Rheumatoid Arthritis and Specified Autoimmune 4.802 4.534 4.429 4.288 4.270
Disorders........................................
Systemic Lupus Erythematosus and Other Autoimmune 1.211 1.106 1.002 0.884 0.852
Disorders........................................
Osteogenesis Imperfecta and Other Osteodystrophies 1.112 1.008 0.919 0.822 0.799
Congenital/Developmental Skeletal and Connective 1.112 1.008 0.919 0.822 0.799
Tissue Disorders.................................
Cleft Lip/Cleft Palate............................ 0.852 0.729 0.606 0.470 0.433
Hemophilia........................................ 59.554 59.072 58.973 58.779 58.763
Myelodysplastic Syndromes and Myelofibrosis....... 11.606 11.431 11.349 11.244 11.231
Aplastic Anemia................................... 11.606 11.431 11.349 11.244 11.231
Acquired Hemolytic Anemia, Including Hemolytic 11.606 11.431 11.349 11.244 11.231
Disease of Newborn...............................
Sickle Cell Anemia (Hb-SS) and Thalassemia Beta 3.359 3.193 3.083 2.958 2.929
Zero.............................................
Sickle-Cell Disorders, Except Sickle-Cell Anemia 3.359 3.193 3.083 2.958 2.929
(Hb-SS) and Thalassemia Beta Zero; Beta
Thalassemia Major................................
Combined and Other Severe Immunodeficiencies...... 5.693 5.547 5.470 5.368 5.350
Disorders of the Immune Mechanism................. 5.693 5.547 5.470 5.368 5.350
Coagulation Defects and Other Specified 4.135 4.022 3.937 3.839 3.817
Hematological Disorders..........................
Drug Use with Psychotic Complications............. 2.239 2.101 1.978 1.833 1.799
Drug Use Disorder, Moderate/Severe, or Drug Use 2.239 2.101 1.978 1.833 1.799
with Non-Psychotic Complications.................
Alcohol Use with Psychotic Complications.......... 0.811 0.683 0.540 0.377 0.338
Alcohol Use Disorder, Moderate/Severe, or Alcohol 0.811 0.683 0.540 0.377 0.338
Use with Specified Non-Psychotic Complications...
Schizophrenia..................................... 3.875 3.617 3.437 3.224 3.185
Delusional and Other Specified Psychotic 3.273 3.038 2.852 2.625 2.575
Disorders, Unspecified Psychosis.................
Major Depressive Disorder, Severe, and Bipolar 2.710 2.509 2.352 2.169 2.126
Disorders........................................
Personality Disorders............................. 0.597 0.513 0.416 0.311 0.277
Anorexia/Bulimia Nervosa.......................... 2.132 1.994 1.886 1.751 1.717
Prader-Willi, Patau, Edwards, and Autosomal 12.106 12.042 12.004 11.952 11.938
Deletion Syndromes...............................
Down Syndrome, Fragile X, Other Chromosomal 0.799 0.693 0.601 0.491 0.463
Anomalies, and Congenital Malformation Syndromes.
Autistic Disorder................................. 2.710 2.509 2.352 2.169 2.126
Pervasive Developmental Disorders, Except Autistic 0.597 0.513 0.416 0.321 0.297
Disorder.........................................
Traumatic Complete Lesion Cervical Spinal Cord.... 10.342 10.139 10.066 9.954 9.944
Quadriplegia...................................... 10.342 10.139 10.066 9.954 9.944
Traumatic Complete Lesion Dorsal Spinal Cord...... 7.706 7.483 7.370 7.223 7.201
Paraplegia........................................ 7.706 7.483 7.370 7.223 7.201
Spinal Cord Disorders/Injuries.................... 4.354 4.171 4.045 3.880 3.841
Amyotrophic Lateral Sclerosis and Other Anterior 44.922 44.615 44.563 44.454 44.447
Horn Cell Disease................................
Quadriplegic Cerebral Palsy....................... 1.301 1.125 1.017 0.881 0.861
Cerebral Palsy, Except Quadriplegic............... 0.394 0.278 0.202 0.113 0.091
Spina Bifida and Other Brain/Spinal/Nervous System 1.403 1.295 1.208 1.102 1.078
Congenital Anomalies.............................
Myasthenia Gravis/Myoneural Disorders and Guillain- 11.196 11.067 11.035 10.986 10.988
Barre Syndrome/Inflammatory and Toxic Neuropathy.
Muscular Dystrophy................................ 6.335 6.182 6.087 5.966 5.942
Multiple Sclerosis................................ 7.535 7.183 7.067 6.898 6.885
Parkinson's, Huntington's, and Spinocerebellar 6.335 6.182 6.087 5.966 5.942
Disease, and Other Neurodegenerative Disorders...
Seizure Disorders and Convulsions................. 1.519 1.389 1.256 1.104 1.063
Hydrocephalus..................................... 11.643 11.592 11.599 11.603 11.602
Nontraumatic Coma, Except Diabetic, Hepatic, or 11.490 11.480 11.484 11.487 11.485
Hypoglycemic; Nontraumatic Brain Compression/
Anoxic Damage....................................
Narcolepsy and Cataplexy.......................... 3.550 3.402 3.296 3.156 3.115
Respirator Dependence/Tracheostomy Status......... 26.852 26.609 26.531 26.418 26.408
Respiratory Arrest................................ 15.129 14.889 14.754 14.581 14.559
Cardio-Respiratory Failure and Shock, Including 15.129 14.889 14.754 14.581 14.559
Respiratory Distress Syndromes...................
Heart Assistive Device/Artificial Heart........... 15.155 15.082 15.015 14.930 14.907
Heart Transplant Status/Complications............. 15.155 15.082 15.015 14.930 14.907
Heart Failure..................................... 3.656 3.549 3.481 3.391 3.370
Acute Myocardial Infarction....................... 0.225 0.196 0.157 0.107 0.088
Unstable Angina and Other Acute Ischemic Heart 0.225 0.196 0.157 0.107 0.088
Disease..........................................
Heart Infection/Inflammation, Except Rheumatic.... 15.433 15.322 15.236 15.136 15.111
Hypoplastic Left Heart Syndrome and Other Severe 3.711 3.564 3.444 3.307 3.273
Congenital Heart Disorders.......................
Major Congenital Heart/Circulatory Disorders...... 0.962 0.862 0.757 0.652 0.624
[[Page 11013]]
Atrial and Ventricular Septal Defects, Patent 0.525 0.439 0.352 0.268 0.248
Ductus Arteriosus, and Other Congenital Heart/
Circulatory Disorders............................
Specified Heart Arrhythmias....................... 3.136 2.983 2.882 2.759 2.732
Intracranial Hemorrhage........................... 12.158 12.048 12.010 11.963 11.955
Ischemic or Unspecified Stroke.................... 0.531 0.420 0.353 0.272 0.255
Cerebral Aneurysm and Arteriovenous Malformation.. 0.813 0.690 0.607 0.502 0.480
Hemiplegia/Hemiparesis............................ 4.230 4.089 3.989 3.861 3.834
Monoplegia, Other Paralytic Syndromes............. 2.776 2.633 2.537 2.417 2.392
Atherosclerosis of the Extremities with Ulceration 10.094 9.865 9.741 9.588 9.568
or Gangrene......................................
Vascular Disease with Complications............... 12.595 12.449 12.389 12.300 12.286
Pulmonary Embolism and Deep Vein Thrombosis....... 19.285 19.147 19.070 18.968 18.947
Lung Transplant Status/Complications.............. 15.155 15.082 15.015 14.930 14.907
Cystic Fibrosis................................... 49.902 49.319 49.258 49.095 49.105
Chronic Obstructive Pulmonary Disease, Including 1.825 1.669 1.534 1.379 1.342
Bronchiectasis...................................
Severe Asthma..................................... 1.253 1.093 0.929 0.748 0.704
Asthma, Except Severe............................. 0.323 0.248 0.165 0.092 0.072
Fibrosis of Lung and Other Lung Disorders......... 1.444 1.329 1.211 1.083 1.051
Aspiration and Specified Bacterial Pneumonias and 11.365 11.349 11.403 11.462 11.475
Other Severe Lung Infections.....................
Kidney Transplant Status/Complications............ 11.308 11.349 11.403 11.462 11.475
End Stage Renal Disease........................... 23.942 23.682 23.657 23.578 23.576
Chronic Kidney Disease, Stage 5................... 2.630 2.522 2.430 2.344 2.325
Chronic Kidney Disease, Severe (Stage 4).......... 2.630 2.522 2.430 2.344 2.325
Ectopic and Molar Pregnancy....................... 0.988 0.833 0.642 0.431 0.386
Miscarriage with Complications.................... 0.526 0.409 0.233 0.036 0.005
Miscarriage with No or Minor Complications........ 0.526 0.409 0.233 0.036 0.005
Pregnancy with Delivery with Major Complications.. 3.019 2.757 2.391 1.934 1.805
Pregnancy with Delivery with Complications........ 3.019 2.757 2.391 1.934 1.805
Pregnancy with Delivery with No or Minor 2.183 1.972 1.629 1.180 1.023
Complications....................................
(Ongoing) Pregnancy without Delivery with Major 0.513 0.378 0.189 0.011 0.000
Complications....................................
(Ongoing) Pregnancy without Delivery with 0.513 0.378 0.189 0.011 0.000
Complications....................................
(Ongoing) Pregnancy without Delivery with No or 0.284 0.182 0.068 0.000 0.000
Minor Complications..............................
Chronic Ulcer of Skin, Except Pressure............ 2.113 2.020 1.939 1.855 1.833
Extensive Third Degree Burns...................... 22.256 22.021 21.922 21.792 21.772
Major Skin Burn or Condition...................... 2.590 2.420 2.281 2.120 2.083
Severe Head Injury................................ 22.256 22.021 21.922 21.792 21.772
Hip and Pelvic Fractures.......................... 4.114 3.906 3.772 3.623 3.596
Vertebral Fractures without Spinal Cord Injury.... 4.144 3.952 3.811 3.639 3.600
Traumatic Amputations and Amputation Complications 3.694 3.520 3.372 3.192 3.147
Stem Cell, Including Bone Marrow, Transplant 15.155 15.082 15.015 14.930 14.907
Status/Complications.............................
Artificial Openings for Feeding or Elimination.... 4.495 4.323 4.257 4.161 4.151
Amputation Status, Upper Limb or Lower Limb....... 3.694 3.520 3.372 3.192 3.147
----------------------------------------------------------------------------------------------------------------
Interacted HCC Counts Factors
----------------------------------------------------------------------------------------------------------------
Severe illness, 1 payment HCC..................... -11.308 -11.349 -11.403 -11.462 -11.475
Severe illness, 2 payment HCCs.................... -11.308 -11.349 -11.403 -11.462 -11.475
Severe illness, 3 payment HCCs.................... -10.149 -10.211 -10.174 -10.162 -10.141
Severe illness, 4 payment HCCs.................... -9.055 -9.082 -8.919 -8.762 -8.697
Severe illness, 5 payment HCCs.................... -8.454 -8.416 -8.172 -7.938 -7.853
Severe illness, 6 or 7 payment HCCs............... -4.190 -3.978 -3.561 -3.133 -3.003
Severe illness, 8 or more payment HCCs............ 18.133 18.860 19.604 20.422 20.625
Transplant severe illness, 4 or more payment HCCs. 15.299 15.306 15.287 15.271 15.267
----------------------------------------------------------------------------------------------------------------
Affiliated Cost Factors
----------------------------------------------------------------------------------------------------------------
HIV Pre-Exposure Prophylaxis (PrEP)............... 2.089 2.042 1.984 1.923 1.905
----------------------------------------------------------------------------------------------------------------
3. On page 6317, the table titled ``TABLE 3: HHS HCCs Selected for
the HCC Interacted Counts Variables for the Adult and Child Models for
the 2027 Benefit Year'' is corrected to read as follows:
Table 3--HHS HCCs Selected for the HCC Interacted Counts Variables for
the Adult and Child Models for the 2027 Benefit Year
------------------------------------------------------------------------
Severity illness Transplant
Payment HCC indicator indicator
------------------------------------------------------------------------
HCC 2 Septicemia, Sepsis, Systemic X ................
Inflammatory Response Syndrome/
Shock..............................
HCC 3 Central Nervous System X ................
Infections, Except Viral Meningitis
[[Page 11014]]
HCC 4 Viral or Unspecified X ................
Meningitis.........................
HCC 6 Opportunistic Infections...... X ................
HCC 23 Protein-Calorie Malnutrition. X ................
HCC 34 Liver Transplant Status/ X X
Complications......................
HCC 41 Intestine Transplant Status/ X X
Complications......................
HCC 42 Peritonitis/Gastrointestinal X ................
Perforation/Necrotizing
Enterocolitis......................
HCC 96 Prader-Willi, Patau, Edwards, X ................
and Autosomal Deletion Syndromes...
HCC 121 Hydrocephalus............... X ................
HCC 122 Nontraumatic Coma, Except X ................
Diabetic, Hepatic, or Hypoglycemic;
Nontraumatic Brain Compression/
Anoxic Damage......................
HCC 125 Respirator Dependence/ X ................
Tracheostomy Status................
HCC 135 Heart Infection/ X ................
Inflammation, Except Rheumatic.....
HCC 145 Intracranial Hemorrhage..... X ................
HCC 156 Pulmonary Embolism and Deep X ................
Vein Thrombosis....................
HCC 158 Lung Transplant Status/ X X
Complications......................
HCC 163 Aspiration and Specified X ................
Bacterial Pneumonias and Other
Severe Lung Infections.............
HCC 218 Extensive Third Degree Burns X ................
HCC 223 Severe Head Injury.......... X ................
HCC 251 Stem Cell, Including Bone X X
Marrow, Transplant Status/
Complications......................
G13 (Includes HCC 126 Respiratory X ................
Arrest and HCC 127 Cardio-
Respiratory Failure and Shock,
Including Respiratory Distress
Syndromes).........................
G14 (Includes HCC 128 Heart X X
Assistive Device/Artificial Heart
and HCC 129 Heart Transplant Status/
Complications).....................
G24 (Includes HCC 18 Pancreas X X
Transplant Status and HCC 183
Kidney Transplant Status/
Complications).....................
------------------------------------------------------------------------
4. On page 6318, top half of the page, the table titled ``TABLE 4:
Proposed Infant Risk Adjustment Model Factors for the 2027 Benefit
Year'' is corrected to read as follows:
Table 4--Proposed Infant Risk Adjustment Model Factors for the 2027 Benefit Year
----------------------------------------------------------------------------------------------------------------
Group Platinum Gold Silver Bronze Catastrophic
----------------------------------------------------------------------------------------------------------------
Extremely Immature * Severity Level 5 (Highest)... 197.671 196.159 195.801 195.221 195.198
Extremely Immature * Severity Level 4............. 129.748 128.048 127.479 126.693 126.619
Extremely Immature * Severity Level 3............. 29.087 27.703 27.191 26.528 26.453
Extremely Immature * Severity Level 2............. 29.087 27.703 27.191 26.528 26.453
Extremely Immature * Severity Level 1 (Lowest).... 29.087 27.703 27.191 26.528 26.453
Immature * Severity Level 5 (Highest)............. 123.452 121.973 121.649 121.124 121.107
Immature * Severity Level 4....................... 67.497 65.845 65.420 64.760 64.712
Immature * Severity Level 3....................... 29.087 27.703 27.191 26.528 26.453
Immature * Severity Level 2....................... 22.383 21.155 20.619 19.967 19.876
Immature * Severity Level 1 (Lowest).............. 21.881 20.636 20.094 19.436 19.346
Premature/Multiples * Severity Level 5 (Highest).. 107.440 105.978 105.584 105.002 104.960
Premature/Multiples * Severity Level 4............ 27.962 26.600 26.069 25.389 25.317
Premature/Multiples * Severity Level 3............ 12.192 11.287 10.647 9.906 9.741
Premature/Multiples * Severity Level 2............ 7.667 6.967 6.351 5.654 5.480
Premature/Multiples * Severity Level 1 (Lowest)... 5.481 4.884 4.306 3.679 3.503
Term * Severity Level 5 (Highest)................. 80.094 78.884 78.453 77.860 77.791
Term * Severity Level 4........................... 16.487 15.512 14.880 14.150 14.017
Term * Severity Level 3........................... 5.490 4.920 4.339 3.704 3.528
Term * Severity Level 2........................... 3.764 3.279 2.717 2.108 1.931
Term * Severity Level 1 (Lowest).................. 2.081 1.689 1.247 0.869 0.778
Age1 * Severity Level 5 (Highest)................. 69.546 68.851 68.623 68.313 68.286
Age1 * Severity Level 4........................... 12.005 11.504 11.187 10.827 10.759
Age1 * Severity Level 3........................... 2.842 2.580 2.365 2.151 2.097
Age1 * Severity Level 2........................... 1.802 1.576 1.352 1.132 1.070
Age1 * Severity Level 1 (Lowest).................. 0.569 0.478 0.421 0.380 0.368
Age 0 Male........................................ 0.498 0.460 0.421 0.360 0.340
Age 1 Male........................................ 0.067 0.052 0.032 0.011 0.007
----------------------------------------------------------------------------------------------------------------
5. On page 6318, bottom half of the page, the table titled ``TABLE
5: HHS HCCs Included in Infant Model Maturity Categories'' is corrected
to read as follows:
[[Page 11015]]
Table 5--HHS HCCs Included in Infant Model Maturity Categories
------------------------------------------------------------------------
Maturity category HCC/description
------------------------------------------------------------------------
Extremely Immature................ Extremely Immature Newborns, Birth
weight <500 Grams.
Extremely Immature................ Extremely Immature Newborns,
Including Birth weight 500-749
Grams.
Extremely Immature................ Extremely Immature Newborns,
Including Birth weight 750-999
Grams.
Immature.......................... Premature Newborns, Including Birth
weight 1000-1499 Grams.
Immature.......................... Premature Newborns, Including Birth
weight 1500-1999 Grams.
Premature/Multiples............... Premature Newborns, Including Birth
weight 2000-2499 Grams.
Premature/Multiples............... Other Premature, Low Birth weight,
Malnourished, or Multiple Birth
Newborns.
Term.............................. Term or Post-Term Singleton Newborn,
Normal or High Birth weight.
Age 1............................. All age 1 infants.
------------------------------------------------------------------------
6. On page 6319 through the top half of page 6321, the table titled
``TABLE 6: HHS HCCs Included in Infant Model Severity Categories'' is
corrected to read as follows:
Table 6--HHS HCCs Included in Infant Model Severity Categories
------------------------------------------------------------------------
Severity category HCC/description
------------------------------------------------------------------------
Severity Level 5 (Highest)........ Metastatic Cancer.
Severity Level 5.................. Pancreas Transplant Status.
Severity Level 5.................. Liver Transplant Status/
Complications.
Severity Level 5.................. Intestine Transplant Status/
Complications.
Severity Level 5.................. Peritonitis/Gastrointestinal
Perforation/Necrotizing
Enterocolitis.
Severity Level 5.................. Respirator Dependence/Tracheostomy
Status.
Severity Level 5.................. Heart Assistive Device/Artificial
Heart.
Severity Level 5.................. Heart Transplant Status/
Complications.
Severity Level 5.................. Heart Failure.
Severity Level 5.................. Hypoplastic Left Heart Syndrome and
Other Severe Congenital Heart
Disorders.
Severity Level 5.................. Lung Transplant Status/
Complications.
Severity Level 5.................. Kidney Transplant Status/
Complications.
Severity Level 5.................. End Stage Renal Disease.
Severity Level 5.................. Stem Cell, Including Bone Marrow,
Transplant Status/Complications.
Severity Level 4.................. Septicemia, Sepsis, Systemic
Inflammatory Response Syndrome/
Shock.
Severity Level 4.................. Lung, Brain, and Other Severe
Cancers, Including Pediatric Acute
Lymphoid Leukemia.
Severity Level 4.................. Mucopolysaccharidosis.
Severity Level 4.................. Adrenal, Pituitary, and Other
Significant Endocrine Disorders.
Severity Level 4.................. Acute Liver Failure/Disease,
Including Neonatal Hepatitis.
Severity Level 4.................. Chronic Liver Failure/End-Stage
Liver Disorders.
Severity Level 4.................. Major Congenital Anomalies of
Diaphragm, Abdominal Wall, and
Esophagus, Age <2.
Severity Level 4.................. Myelodysplastic Syndromes and
Myelofibrosis.
Severity Level 4.................. Aplastic Anemia.
Severity Level 4.................. Combined and Other Severe
Immunodeficiencies.
Severity Level 4.................. Traumatic Complete Lesion Cervical
Spinal Cord.
Severity Level 4.................. Quadriplegia.
Severity Level 4.................. Amyotrophic Lateral Sclerosis and
Other Anterior Horn Cell Disease.
Severity Level 4.................. Quadriplegic Cerebral Palsy.
Severity Level 4.................. Myasthenia Gravis/Myoneural
Disorders and Guillain-Barre
Syndrome/Inflammatory and Toxic
Neuropathy.
Severity Level 4.................. Nontraumatic Coma, Except Diabetic,
Hepatic, or Hypoglycemic;
Nontraumatic Brain Compression/
Anoxic Damage.
Severity Level 4.................. Respiratory Arrest.
Severity Level 4.................. Cardio-Respiratory Failure and
Shock, Including Respiratory
Distress Syndromes.
Severity Level 4.................. Acute Myocardial Infarction.
Severity Level 4.................. Heart Infection/Inflammation, Except
Rheumatic.
Severity Level 4.................. Major Congenital Heart/Circulatory
Disorders.
Severity Level 4.................. Intracranial Hemorrhage.
Severity Level 4.................. Ischemic or Unspecified Stroke.
Severity Level 4.................. Vascular Disease with Complications.
Severity Level 4.................. Pulmonary Embolism and Deep Vein
Thrombosis.
Severity Level 4.................. Aspiration and Specified Bacterial
Pneumonias and Other Severe Lung
Infections.
Severity Level 4.................. Chronic Kidney Disease, Stage 5.
Severity Level 4.................. Artificial Openings for Feeding or
Elimination.
Severity Level 3.................. HIV/AIDS.
Severity Level 3.................. Central Nervous System Infections,
Except Viral Meningitis.
Severity Level 3.................. Opportunistic Infections.
Severity Level 3.................. Non-Hodgkin Lymphomas and Other
Cancers and Tumors.
Severity Level 3.................. Colorectal, Breast (Age <50),
Kidney, and Other Cancers.
Severity Level 3.................. Breast (Age 50+) and Prostate
Cancer, Benign/Uncertain Brain
Tumors, and Other Cancers and
Tumors.
Severity Level 3.................. Lipidoses and Glycogenosis.
Severity Level 3.................. Intestinal Obstruction.
Severity Level 3.................. Necrotizing Fasciitis.
Severity Level 3.................. Bone/Joint/Muscle Infections/
Necrosis.
[[Page 11016]]
Severity Level 3.................. Osteogenesis Imperfecta and Other
Osteodystrophies.
Severity Level 3.................. Cleft Lip/Cleft Palate.
Severity Level 3.................. Hemophilia.
Severity Level 3.................. Sickle Cell Anemia (Hb-SS) and
Thalassemia Beta Zero.
Severity Level 3.................. Disorders of the Immune Mechanism.
Severity Level 3.................. Coagulation Defects and Other
Specified Hematological Disorders.
Severity Level 3.................. Drug Use with Psychotic
Complications.
Severity Level 3.................. Drug Use Disorder, Moderate/Severe,
or Drug Use with Non-Psychotic
Complications.
Severity Level 3.................. Alcohol Use with Psychotic
Complications.
Severity Level 3.................. Alcohol Use Disorder, Moderate/
Severe, or Alcohol Use with
Specified Non-Psychotic
Complications.
Severity Level 3.................. Prader-Willi, Patau, Edwards, and
Autosomal Deletion Syndromes.
Severity Level 3.................. Traumatic Complete Lesion Dorsal
Spinal Cord.
Severity Level 3.................. Paraplegia.
Severity Level 3.................. Spinal Cord Disorders/Injuries.
Severity Level 3.................. Cerebral Palsy, Except Quadriplegic.
Severity Level 3.................. Spina Bifida and Other Brain/Spinal/
Nervous System Congenital
Anomalies.
Severity Level 3.................. Muscular Dystrophy.
Severity Level 3.................. Parkinson's, Huntington's, and
Spinocerebellar Disease, and Other
Neurodegenerative Disorders.
Severity Level 3.................. Hydrocephalus.
Severity Level 3.................. Unstable Angina and Other Acute
Ischemic Heart Disease.
Severity Level 3.................. Atrial and Ventricular Septal
Defects, Patent Ductus Arteriosus,
and Other Congenital Heart/
Circulatory Disorders.
Severity Level 3.................. Specified Heart Arrhythmias.
Severity Level 3.................. Cerebral Aneurysm and Arteriovenous
Malformation.
Severity Level 3.................. Hemiplegia/Hemiparesis.
Severity Level 3.................. Cystic Fibrosis.
Severity Level 3.................. Extensive Third Degree Burns.
Severity Level 3.................. Severe Head Injury.
Severity Level 3.................. Hip and Pelvic Fractures.
Severity Level 3.................. Vertebral Fractures without Spinal
Cord Injury.
Severity Level 2.................. Viral or Unspecified Meningitis.
Severity Level 2.................. Thyroid Cancer, Melanoma,
Neurofibromatosis, and Other
Cancers and Tumors.
Severity Level 2.................. Diabetes with Acute Complications.
Severity Level 2.................. Diabetes with Chronic Complications.
Severity Level 2.................. Diabetes without Complication.
Severity Level 2.................. Protein-Calorie Malnutrition.
Severity Level 2.................. Congenital Metabolic Disorders, Not
Elsewhere Classified.
Severity Level 2.................. Amyloidosis, Porphyria, and Other
Metabolic Disorders.
Severity Level 2.................. Cirrhosis of Liver.
Severity Level 2.................. Chronic Pancreatitis.
Severity Level 2.................. Acute Pancreatitis.
Severity Level 2.................. Inflammatory Bowel Disease.
Severity Level 2.................. Rheumatoid Arthritis and Specified
Autoimmune Disorders.
Severity Level 2.................. Systemic Lupus Erythematosus and
Other Autoimmune Disorders.
Severity Level 2.................. Congenital/Developmental Skeletal
and Connective Tissue Disorders.
Severity Level 2.................. Acquired Hemolytic Anemia, Including
Hemolytic Disease of Newborn.
Severity Level 2.................. Sickle-Cell Disorders, Except Sickle-
Cell Anemia (Hb-SS) and Thalassemia
Beta Zero; Beta Thalassemia Major.
Severity Level 2.................. Down Syndrome, Fragile X, Other
Chromosomal Anomalies, and
Congenital Malformation Syndromes.
Severity Level 2.................. Seizure Disorders and Convulsions.
Severity Level 2.................. Monoplegia, Other Paralytic
Syndromes.
Severity Level 2.................. Atherosclerosis of the Extremities
with Ulceration or Gangrene.
Severity Level 2.................. Chronic Obstructive Pulmonary
Disease, Including Bronchiectasis.
Severity Level 2.................. Severe Asthma.
Severity Level 2.................. Fibrosis of Lung and Other Lung
Disorders.
Severity Level 2.................. Chronic Kidney Disease, Severe
(Stage 4).
Severity Level 2.................. Chronic Ulcer of Skin, Except
Pressure.
Severity Level 2.................. Major Skin Burn or Condition.
Severity Level 1 (Lowest)......... Chronic Viral Hepatitis C.
Severity Level 1.................. Chronic Hepatitis, Except Chronic
Viral Hepatitis C.
Severity Level 1.................. Autistic Disorder.
Severity Level 1.................. Pervasive Developmental Disorders,
Except Autistic Disorder.
Severity Level 1.................. Multiple Sclerosis.
Severity Level 1.................. Asthma, Except Severe.
Severity Level 1.................. Traumatic Amputations and Amputation
Complications.
Severity Level 1.................. Amputation Status, Upper Limb or
Lower Limb.
------------------------------------------------------------------------
7. On page 6321, bottom half of the page, the table titled ``TABLE
7: R-Squared Statistics for Proposed 2027 Benefit Year HHS Risk
Adjustment Models'' is corrected to read as follows:
[[Page 11017]]
Table 7--R-Squared Statistics for Proposed 2027 Benefit Year HHS Risk Adjustment Models
----------------------------------------------------------------------------------------------------------------
BY2021 Enrollee- BY2022 Enrollee- BY2023 Enrollee-
Model level EDGE data level EDGE data level EDGE data
----------------------------------------------------------------------------------------------------------------
Platinum Adult......................................... 0.4213 0.4094 0.4152
Gold Adult............................................. 0.4154 0.4032 0.4089
Silver Adult........................................... 0.4122 0.3996 0.4048
Bronze Adult........................................... 0.4077 0.3948 0.3996
Catastrophic Adult..................................... 0.4068 0.3937 0.3982
Platinum Child......................................... 0.3569 0.3639 0.3412
Gold Child............................................. 0.3540 0.3612 0.3381
Silver Child........................................... 0.3516 0.3588 0.3357
Bronze Child........................................... 0.3484 0.3555 0.3324
Catastrophic Child..................................... 0.3474 0.3545 0.3314
Platinum Infant........................................ 0.3099 0.2883 0.2727
Gold Infant............................................ 0.3062 0.2847 0.2687
Silver Infant.......................................... 0.3044 0.2827 0.2667
Bronze Infant.......................................... 0.3019 0.2802 0.2640
Catastrophic Infant.................................... 0.3014 0.2797 0.2635
----------------------------------------------------------------------------------------------------------------
Liesl I. Fowler,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2026-04467 Filed 3-5-26; 8:45 am]
BILLING CODE 4120-01-P
</pre></body>
</html>Indexed from Federal Register on March 6, 2026.
This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.