42 C.F.R. § 425.659

Calculating risk scores used in Shared Savings Program benchmark calculations.

§ 425.659 Calculating risk scores used in Shared Savings Program benchmark calculations.

(a) General. CMS accounts for differences in severity and case mix of the ACO's assigned beneficiaries and assignable beneficiaries (as defined under § 425.20) in calculations used in establishing, adjusting, and updating the ACO's historical benchmark.

(b) Prospective Hierarchical Condition Category (HCC) risk score calculation. In determining Medicare FFS beneficiary prospective HCC risk scores for a performance year and each benchmark year of the ACO's agreement period, CMS does the following:

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