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Bug in CMS HCC mart for 65+ patients with OREC of Disabled #674

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sarah-tuva opened this issue Nov 21, 2024 · 0 comments
Open

Bug in CMS HCC mart for 65+ patients with OREC of Disabled #674

sarah-tuva opened this issue Nov 21, 2024 · 0 comments
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bug Something isn't working community Label for issues created by community members

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@sarah-tuva
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Describe the bug - Required
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Bug reported via Slack:

@sarah](https://thetuvaproject.slack.com/team/U03GL5Z3C3U)
On further research, it appears that OREC of disabled is only used for patients <65 yo who are therefore qualified because of disability. Once 65+ they qualify by “aged”. The OREC remains as a flag for original entitlement, but demographic RAF switches to the AGED column. From CMS:
"Disabled Status : The disabled factors for enrollees under 65 years old are labeled as "disabled" and those over 65 years old are labeled as "aged." Under the CMS-HCC model, additional payments are made for Medicaid eligible disabled individuals." https://www.csscoperations.com/internet/csscw3_files.nsf/F/CSSCra-particpantguide_120607.pdf/$FILE/ra-particpantguide_120607.pdf
AND
"an originally disabled indicator, flagging beneficiaries who were entitled by disability when they joined Medicare but are currently entitled by age;" https://www.cms.gov/aco-reach-kcc-py2025-risk-adjust-paper
I believe the cms_hcc logic should be amended to use the equivalent ‘aged’ column when a disabled patient becomes 65+ (new or continuing). I.e. CND_M60_64=>CNA_M65_69 when he turns 65.


Environment - Required

  • Tuva project package version (e.g. 0.6.0): 0.12.5
  • dbt version (e.g. 1.7): any
  • dbt type (e.g. dbt cloud or dbt CLI): any
  • Data warehouse (e.g. Snowflake): any

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@sarah-tuva sarah-tuva added bug Something isn't working community Label for issues created by community members labels Nov 21, 2024
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