New Rx HCC Model
The Part D Hierarchical Condition Category (RxHCC) model was updated in the 2022 final rule and can have an impact on MA organizations’ bottom lines. The risk score calculations will be made based on 2017 diagnoses paired with 2018 drug data, each one being updated every three years.
The RxHCC will be based only on encounter data, which will be a problem for most organizations, due to the delayed or foregone care. Estimates show an across-the-board risk score decrease for RxHCC, which can only mean reduced revenue for MA organizations on drug costs. Even so, plans can expect to recover the losses in the upcoming year, as more beneficiaries will resume in-person care.
