Medicare Risk Adjustment for the Frail Elderly

CMS has had a continuing interest in exploring ways to incorporate frailty adjustment into the CMS Hierarchical Condition Categories (CMS-HCC) risk adjustment methodology for Medicare Advantage and other Medicare private organizations. In this article we present research results for Medicare risk adjustment of the frail elderly since the adoption of frailty adjustment for Program of All-Inclusive Care for the Elderly (PACE) organizations in 2004. In particular, we present results on the revised frailty adjuster that is being phased in for PACE organizations between 2008 and 2012.