Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: January 22, 2019

Program Area: Risk Adjustment (RA)

Question: Has the Centers for Medicare & Medicaid Services (CMS) released a list of the age and sex claim edits?

Answer: Information on age and sex edits can be found in the 2018 Benefit Year Risk Adjustment: Updated HHS-Developed Risk Adjustment Model Algorithm "Do It Yourself (DIY)" Software released annually unless changes are made throughout the year. The latest publication of the DIY was on December 4, 2018, are available on the Center for Consumer Information and Insurance Oversight (CCIIO) website at: Updated 2018 DIY Instructions https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/CY2018-DIY-instructions.pdf Technical Details www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/2018-RA-Model-DIY-Tables.xlsx Updated 2018 SAS Software https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/HHS-HCC-software.zip

HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.