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Proposed Rule

Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program; Correction

A Proposed Rule by the Centers for Medicare & Medicaid Services on 03/06/2026

• 1.

1.

• Document Details Published Content - Document Details Agencies Department of Health and Human Services Centers for Medicare & Medicaid Services Office of the Secretary Agency/Docket Number CMS-9883-CN CFR 42 CFR 600 45 CFR 153 45 CFR 154 45 CFR 155 45 CFR 156 45 CFR 158 Document Citation 91 FR 11006 Document Number 2026-04467 Document Type Proposed Rule Pages 11006-11017
  (12 pages) Publication Date 03/06/2026 RIN 0938-AV62 Published Content - Document Details

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• Document Details Published Content - Document Details Agencies Department of Health and Human Services Centers for Medicare & Medicaid Services Office of the Secretary Agency/Docket Number CMS-9883-CN CFR 42 CFR 600 45 CFR 153 45 CFR 154 45 CFR 155 45 CFR 156 45 CFR 158 Document Citation 91 FR 11006 Document Number 2026-04467 Document Type Proposed Rule Pages 11006-11017
  (12 pages) Publication Date 03/06/2026 RIN 0938-AV62 Published Content - Document Details

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  • DATES:
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  • I. Background
  • II. Summary of Errors
  • III. Correction of Errors Enhanced Content - Table of Contents

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Department of Health and Human Services

Centers for Medicare & Medicaid Services

Office of the Secretary

1. 42 CFR Part 600
2. 45 CFR Parts 153, 154, 155, 156, and 158
3. [CMS-9883-CN]
4. RIN 0938-AV62

AGENCY:

Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS).

( printed page 11007)

ACTION:

Proposed rule; correction.

SUMMARY:

This document corrects technical errors in the proposed rule that appeared in the February 11, 2026, Federal Register titled “Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program.”

DATES:

This correction is effective March 6, 2026.

FOR FURTHER INFORMATION CONTACT:

Jeff Wu, (301) 492-4305, Rogelyn McLean, (410) 786-1524, Grace Bristol, (410) 786-8437, for general information.

Ayesha Anwar, (301) 448-3625, or Joshua Paul, (301) 492-4347, for matters related to the HHS-operated risk adjustment and risk adjustment data validation (HHS-RADV) programs.

SUPPLEMENTARY INFORMATION:

I. Background

In FR Doc. 2026-02769 of February 11, 2026 (91 FR 6292), there were a number of technical errors that are identified and corrected in this correcting document.

II. Summary of Errors

On pages 6306 through 6319, we inadvertently omitted column headings in Tables 1 through 7.

III. Correction of Errors

In FR Doc. 2026-02769 of February 11, 2026 (91 FR 6292), make the following corrections:

1. On pages 6306 through 6312, the table titled “TABLE 1: Proposed Adult Risk Adjustment Model Factors for the 2027 Benefit Year” is corrected to read as follows:

| HCC or RXC No. | Factor | Platinum | Gold | Silver | Bronze | Catastrophic |
| --- | --- | --- | --- | --- | --- | --- |
| Demographic Factors | | | | | | |
| | Age 21-24, Male | 0.189 | 0.135 | 0.097 | 0.068 | 0.060 |
| | Age 25-29, Male | 0.201 | 0.142 | 0.100 | 0.067 | 0.059 |
| | Age 30-34, Male | 0.231 | 0.166 | 0.118 | 0.080 | 0.070 |
| | Age 35-39, Male | 0.252 | 0.183 | 0.130 | 0.088 | 0.076 |
| | Age 40-44, Male | 0.280 | 0.206 | 0.149 | 0.101 | 0.088 |
| | Age 45-49, Male | 0.322 | 0.244 | 0.183 | 0.132 | 0.118 |
| | Age 50-54, Male | 0.371 | 0.286 | 0.219 | 0.163 | 0.147 |
| | Age 55-59, Male | 0.413 | 0.322 | 0.250 | 0.188 | 0.171 |
| | Age 60-64, Male | 0.467 | 0.366 | 0.286 | 0.216 | 0.198 |
| | Age 21-24, Female | 0.278 | 0.196 | 0.132 | 0.082 | 0.067 |
| | Age 25-29, Female | 0.311 | 0.221 | 0.149 | 0.091 | 0.074 |
| | Age 30-34, Female | 0.384 | 0.288 | 0.209 | 0.144 | 0.126 |
| | Age 35-39, Female | 0.435 | 0.335 | 0.253 | 0.184 | 0.166 |
| | Age 40-44, Female | 0.484 | 0.379 | 0.292 | 0.216 | 0.195 |
| | Age 45-49, Female | 0.491 | 0.385 | 0.293 | 0.214 | 0.192 |
| | Age 50-54, Female | 0.506 | 0.397 | 0.302 | 0.219 | 0.197 |
| | Age 55-59, Female | 0.467 | 0.358 | 0.265 | 0.184 | 0.162 |
| | Age 60-64, Female | 0.467 | 0.355 | 0.260 | 0.177 | 0.154 |
| Diagnosis Factors | | | | | | |
| HCC001 | HIV/AIDS | 0.000 | 0.000 | 0.000 | 0.000 | 0.000 |
| HCC002 | Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock | 8.520 | 8.314 | 8.233 | 8.129 | 8.123 |
| HCC003 | Central Nervous System Infections, Except Viral Meningitis | 7.760 | 7.653 | 7.601 | 7.527 | 7.511 |
| HCC004 | Viral or Unspecified Meningitis | 6.855 | 6.746 | 6.678 | 6.590 | 6.569 |
| HCC006 | Opportunistic Infections | 8.110 | 8.053 | 7.995 | 7.916 | 7.892 |
| HCC008 | Metastatic Cancer | 22.129 | 21.703 | 21.654 | 21.525 | 21.533 |
| HCC009 | Lung, Brain, and Other Severe Cancers, Including Pediatric Acute Lymphoid Leukemia | 12.286 | 11.994 | 11.925 | 11.798 | 11.789 |
| HCC010 | Non-Hodgkin Lymphomas and Other Cancers and Tumors | 5.400 | 5.216 | 5.126 | 5.002 | 4.980 |
| HCC011 | Colorectal, Breast (Age <50), Kidney, and Other Cancers | 3.851 | 3.657 | 3.554 | 3.419 | 3.396 |
| HCC012 | Breast (Age 50+) and Prostate Cancer, Benign/Uncertain Brain Tumors, and Other Cancers and Tumors | 2.465 | 2.326 | 2.237 | 2.127 | 2.105 |
| HCC013 | Thyroid Cancer, Melanoma, Neurofibromatosis, and Other Cancers and Tumors | 1.025 | 0.930 | 0.825 | 0.710 | 0.681 |
| HCC018 | Pancreas Transplant Status | 5.506 | 5.552 | 5.642 | 5.734 | 5.757 |
| HCC019 | Diabetes with Acute Complications | 0.189 | 0.145 | 0.102 | 0.060 | 0.050 |
| HCC020 | Diabetes with Chronic Complications | 0.189 | 0.145 | 0.102 | 0.060 | 0.050 |
| HCC021 | Diabetes without Complication | 0.189 | 0.145 | 0.102 | 0.060 | 0.050 |
| HCC022 | Type 1 Diabetes Mellitus, add-on to Diabetes HCCs 19-21 | 0.179 | 0.155 | 0.111 | 0.045 | 0.023 |
| HCC023 | Protein-Calorie Malnutrition | 10.099 | 9.974 | 9.925 | 9.854 | 9.843 |
| HCC026 | Mucopolysaccharidosis | 18.785 | 18.604 | 18.567 | 18.498 | 18.495 |
| HCC027 | Lipidoses and Glycogenosis | 18.785 | 18.604 | 18.567 | 18.498 | 18.495 |
| HCC029 | Amyloidosis, Porphyria, and Other Metabolic Disorders | 5.455 | 5.353 | 5.299 | 5.229 | 5.216 |
| ( printed page 11008) | | | | | | |
| HCC030 | Adrenal, Pituitary, and Other Significant Endocrine Disorders | 1.291 | 1.216 | 1.150 | 1.071 | 1.053 |
| HCC034 | Liver Transplant Status/Complications | 5.506 | 5.552 | 5.642 | 5.734 | 5.757 |
| HCC0351 a | Acute Liver Failure/Disease, Including Neonatal Hepatitis | 6.880 | 6.693 | 6.630 | 6.548 | 6.543 |
| HCC0352 | Chronic Liver Failure/End-Stage Liver Disorders | 2.234 | 2.070 | 2.000 | 1.906 | 1.896 |
| HCC036 | Cirrhosis of Liver | 0.616 | 0.537 | 0.476 | 0.401 | 0.387 |
| HCC0371 | Chronic Viral Hepatitis C | 0.516 | 0.455 | 0.396 | 0.336 | 0.325 |
| HCC0372 | Chronic Hepatitis, Except Chronic Viral Hepatitis C | 0.516 | 0.455 | 0.396 | 0.336 | 0.325 |
| HCC041 | Intestine Transplant Status/Complications | 5.506 | 5.552 | 5.642 | 5.734 | 5.757 |
| HCC042 | Peritonitis/Gastrointestinal Perforation/Necrotizing Enterocolitis | 10.409 | 10.234 | 10.209 | 10.146 | 10.144 |
| HCC045 | Intestinal Obstruction | 4.795 | 4.594 | 4.499 | 4.369 | 4.350 |
| HCC046 | Chronic Pancreatitis | 2.131 | 1.971 | 1.875 | 1.755 | 1.738 |
| HCC047 | Acute Pancreatitis | 2.131 | 1.971 | 1.875 | 1.755 | 1.738 |
| HCC048 | Inflammatory Bowel Disease | 3.007 | 2.889 | 2.788 | 2.652 | 2.614 |
| HCC054 | Necrotizing Fasciitis | 6.731 | 6.567 | 6.536 | 6.475 | 6.470 |
| HCC055 | Bone/Joint/Muscle Infections/Necrosis | 4.138 | 3.961 | 3.912 | 3.843 | 3.843 |
| HCC056 | Rheumatoid Arthritis and Specified Autoimmune Disorders | 1.363 | 1.259 | 1.188 | 1.104 | 1.086 |
| HCC057 | Systemic Lupus Erythematosus and Other Autoimmune Disorders | 0.355 | 0.286 | 0.198 | 0.098 | 0.069 |
| HCC061 | Osteogenesis Imperfecta and Other Osteodystrophies | 1.753 | 1.635 | 1.546 | 1.437 | 1.415 |
| HCC062 | Congenital/Developmental Skeletal and Connective Tissue Disorders | 1.753 | 1.635 | 1.546 | 1.437 | 1.415 |
| HCC063 | Cleft Lip/Cleft Palate | 0.823 | 0.732 | 0.640 | 0.542 | 0.520 |
| HCC066 | Hemophilia | 70.952 | 70.627 | 70.590 | 70.491 | 70.495 |
| HCC067 | Myelodysplastic Syndromes and Myelofibrosis | 9.888 | 9.761 | 9.718 | 9.648 | 9.639 |
| HCC068 | Aplastic Anemia | 9.888 | 9.761 | 9.718 | 9.648 | 9.639 |
| HCC069 | Acquired Hemolytic Anemia, Including Hemolytic Disease of Newborn | 9.888 | 9.761 | 9.718 | 9.648 | 9.639 |
| HCC070 | Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero | 1.833 | 1.725 | 1.635 | 1.537 | 1.518 |
| HCC071 | Sickle-Cell Disorders, Except Sickle-Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major | 1.457 | 1.397 | 1.348 | 1.292 | 1.279 |
| HCC073 | Combined and Other Severe Immunodeficiencies | 4.364 | 4.272 | 4.239 | 4.184 | 4.176 |
| HCC074 | Disorders of the Immune Mechanism | 4.364 | 4.272 | 4.239 | 4.184 | 4.176 |
| HCC075 | Coagulation Defects and Other Specified Hematological Disorders | 2.167 | 2.085 | 2.024 | 1.948 | 1.930 |
| HCC081 | Drug Use with Psychotic Complications | 1.479 | 1.349 | 1.232 | 1.092 | 1.059 |
| HCC082 | Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications | 1.479 | 1.349 | 1.232 | 1.092 | 1.059 |
| HCC083 | Alcohol Use with Psychotic Complications | 0.857 | 0.746 | 0.647 | 0.533 | 0.507 |
| HCC084 | Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications | 0.857 | 0.746 | 0.647 | 0.533 | 0.507 |
| HCC0871 | Schizophrenia | 2.215 | 2.050 | 1.928 | 1.784 | 1.757 |
| HCC0872 | Delusional and Other Specified Psychotic Disorders, Unspecified Psychosis | 2.087 | 1.932 | 1.803 | 1.645 | 1.611 |
| HCC088 | Major Depressive Disorder, Severe, and Bipolar Disorders | 0.927 | 0.831 | 0.728 | 0.609 | 0.578 |
| HCC090 | Personality Disorders | 0.666 | 0.587 | 0.487 | 0.377 | 0.343 |
| HCC094 | Anorexia/Bulimia Nervosa | 1.855 | 1.749 | 1.663 | 1.555 | 1.529 |
| HCC096 | Prader-Willi, Patau, Edwards, and Autosomal Deletion Syndromes | 9.243 | 9.207 | 9.184 | 9.155 | 9.144 |
| HCC097 | Down Syndrome, Fragile X, Other Chromosomal Anomalies, and Congenital Malformation Syndromes | 0.779 | 0.715 | 0.659 | 0.596 | 0.581 |
| HCC102 | Autistic Disorder | 0.670 | 0.590 | 0.496 | 0.397 | 0.367 |
| HCC103 | Pervasive Developmental Disorders, Except Autistic Disorder | 0.666 | 0.587 | 0.487 | 0.377 | 0.343 |
| HCC106 | Traumatic Complete Lesion Cervical Spinal Cord | 9.567 | 9.405 | 9.331 | 9.227 | 9.211 |
| HCC107 | Quadriplegia | 9.567 | 9.405 | 9.331 | 9.227 | 9.211 |
| HCC108 | Traumatic Complete Lesion Dorsal Spinal Cord | 6.337 | 6.186 | 6.106 | 5.994 | 5.975 |
| HCC109 | Paraplegia | 6.337 | 6.186 | 6.106 | 5.994 | 5.975 |
| HCC110 | Spinal Cord Disorders/Injuries | 4.665 | 4.482 | 4.406 | 4.296 | 4.280 |
| HCC111 | Amyotrophic Lateral Sclerosis and Other Anterior Horn Cell Disease | 6.067 | 5.909 | 5.822 | 5.707 | 5.686 |
| HCC112 | Quadriplegic Cerebral Palsy | 0.975 | 0.868 | 0.773 | 0.658 | 0.631 |
| HCC113 | Cerebral Palsy, Except Quadriplegic | 0.426 | 0.363 | 0.300 | 0.229 | 0.210 |
| ( printed page 11009) | | | | | | |
| HCC114 | Spina Bifida and Other Brain/Spinal/Nervous System Congenital Anomalies | 1.116 | 1.035 | 0.959 | 0.864 | 0.841 |
| HCC115 | Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy | 4.927 | 4.844 | 4.822 | 4.783 | 4.779 |
| HCC117 | Muscular Dystrophy | 1.362 | 1.272 | 1.191 | 1.094 | 1.070 |
| HCC118 | Multiple Sclerosis | 2.461 | 2.331 | 2.253 | 2.151 | 2.131 |
| HCC119 | Parkinson's, Huntington's, and Spinocerebellar Disease, and Other Neurodegenerative Disorders | 1.362 | 1.272 | 1.191 | 1.094 | 1.070 |
| HCC120 | Seizure Disorders and Convulsions | 0.929 | 0.840 | 0.758 | 0.660 | 0.637 |
| HCC121 | Hydrocephalus | 8.919 | 8.823 | 8.773 | 8.704 | 8.689 |
| HCC122 | Nontraumatic Coma, Except Diabetic, Hepatic, or Hypoglycemic; Nontraumatic Brain Compression/Anoxic Damage | 9.620 | 9.477 | 9.417 | 9.325 | 9.307 |
| HCC123 | Narcolepsy and Cataplexy | 4.303 | 4.171 | 4.101 | 4.006 | 3.987 |
| HCC125 | Respirator Dependence/Tracheostomy Status | 20.117 | 19.902 | 19.845 | 19.752 | 19.744 |
| HCC126 | Respiratory Arrest | 7.858 | 7.659 | 7.579 | 7.478 | 7.472 |
| HCC127 | Cardio-Respiratory Failure and Shock, Including Respiratory Distress Syndromes | 7.858 | 7.659 | 7.579 | 7.478 | 7.472 |
| HCC128 | Heart Assistive Device/Artificial Heart | 14.408 | 14.322 | 14.312 | 14.307 | 14.304 |
| HCC129 | Heart Transplant Status/Complications | 14.408 | 14.322 | 14.312 | 14.307 | 14.304 |
| HCC130 | Heart Failure | 1.628 | 1.543 | 1.490 | 1.421 | 1.407 |
| HCC131 | Acute Myocardial Infarction | 4.410 | 4.188 | 4.129 | 4.044 | 4.047 |
| HCC132 | Unstable Angina and Other Acute Ischemic Heart Disease | 3.261 | 3.073 | 2.986 | 2.868 | 2.856 |
| HCC135 | Heart Infection/Inflammation, Except Rheumatic | 7.943 | 7.850 | 7.792 | 7.709 | 7.689 |
| HCC137 | Hypoplastic Left Heart Syndrome and Other Severe Congenital Heart Disorders | 2.004 | 1.911 | 1.843 | 1.763 | 1.745 |
| HCC138 | Major Congenital Heart/Circulatory Disorders | 2.004 | 1.911 | 1.843 | 1.763 | 1.745 |
| HCC139 | Atrial and Ventricular Septal Defects, Patent Ductus Arteriosus, and Other Congenital Heart/Circulatory Disorders | 2.004 | 1.911 | 1.843 | 1.763 | 1.745 |
| HCC142 | Specified Heart Arrhythmias | 1.831 | 1.725 | 1.640 | 1.531 | 1.501 |
| HCC145 | Intracranial Hemorrhage | 9.782 | 9.608 | 9.545 | 9.452 | 9.441 |
| HCC146 | Ischemic or Unspecified Stroke | 1.438 | 1.326 | 1.258 | 1.173 | 1.161 |
| HCC149 | Cerebral Aneurysm and Arteriovenous Malformation | 1.977 | 1.859 | 1.772 | 1.659 | 1.634 |
| HCC150 | Hemiplegia/Hemiparesis | 2.618 | 2.497 | 2.459 | 2.405 | 2.403 |
| HCC151 | Monoplegia, Other Paralytic Syndromes | 2.198 | 2.088 | 2.019 | 1.931 | 1.916 |
| HCC153 | Atherosclerosis of the Extremities with Ulceration or Gangrene | 7.585 | 7.409 | 7.407 | 7.376 | 7.389 |
| HCC154 | Vascular Disease with Complications | 4.906 | 4.756 | 4.694 | 4.605 | 4.591 |
| HCC156 | Pulmonary Embolism and Deep Vein Thrombosis | 7.104 | 7.018 | 6.942 | 6.837 | 6.805 |
| HCC158 | Lung Transplant Status/Complications | 11.333 | 11.261 | 11.238 | 11.227 | 11.221 |
| HCC159 | Cystic Fibrosis | 2.992 | 2.873 | 2.799 | 2.714 | 2.700 |
| HCC160 | Chronic Obstructive Pulmonary Disease, Including Bronchiectasis | 0.615 | 0.539 | 0.454 | 0.360 | 0.334 |
| HCC1611 | Severe Asthma | 0.615 | 0.539 | 0.454 | 0.360 | 0.334 |
| HCC1612 | Asthma, Except Severe | 0.615 | 0.539 | 0.454 | 0.360 | 0.334 |
| HCC162 | Fibrosis of Lung and Other Lung Disorders | 1.305 | 1.231 | 1.161 | 1.075 | 1.052 |
| HCC163 | Aspiration and Specified Bacterial Pneumonias and Other Severe Lung Infections | 6.880 | 6.765 | 6.706 | 6.629 | 6.616 |
| HCC174 | Exudative Macular Degeneration | 1.231 | 1.115 | 0.988 | 0.838 | 0.804 |
| HCC183 | Kidney Transplant Status/Complications | 5.506 | 5.552 | 5.642 | 5.734 | 5.757 |
| HCC184 | End Stage Renal Disease | 17.965 | 17.541 | 17.668 | 17.485 | 17.544 |
| HCC187 | Chronic Kidney Disease, Stage 5 | 0.749 | 0.679 | 0.661 | 0.621 | 0.622 |
| HCC188 | Chronic Kidney Disease, Severe (Stage 4) | 0.749 | 0.679 | 0.661 | 0.621 | 0.622 |
| HCC203 | Ectopic and Molar Pregnancy | 1.438 | 1.302 | 1.131 | 0.927 | 0.875 |
| HCC204 | Miscarriage with Complications | 0.638 | 0.554 | 0.420 | 0.253 | 0.193 |
| HCC205 | Miscarriage with No or Minor Complications | 0.638 | 0.554 | 0.420 | 0.253 | 0.193 |
| HCC207 | Pregnancy with Delivery with Major Complications | 3.610 | 3.349 | 3.031 | 2.654 | 2.581 |
| HCC208 | Pregnancy with Delivery with Complications | 3.610 | 3.349 | 3.031 | 2.654 | 2.581 |
| HCC209 | Pregnancy with Delivery with No or Minor Complications | 2.645 | 2.446 | 2.126 | 1.713 | 1.597 |
| HCC210 | (Ongoing) Pregnancy without Delivery with Major Complications | 0.668 | 0.572 | 0.416 | 0.240 | 0.186 |
| HCC211 | (Ongoing) Pregnancy without Delivery with Complications | 0.494 | 0.412 | 0.283 | 0.148 | 0.106 |
| HCC212 | (Ongoing) Pregnancy without Delivery with No or Minor Complications | 0.023 | 0.000 | 0.000 | 0.000 | 0.000 |
| HCC217 | Chronic Ulcer of Skin, Except Pressure | 1.351 | 1.259 | 1.205 | 1.140 | 1.131 |
| HCC218 | Extensive Third Degree Burns | 28.529 | 28.296 | 28.253 | 28.168 | 28.162 |
| ( printed page 11010) | | | | | | |
| HCC219 | Major Skin Burn or Condition | 2.661 | 2.532 | 2.452 | 2.356 | 2.337 |
| HCC223 | Severe Head Injury | 16.085 | 15.926 | 15.853 | 15.744 | 15.724 |
| HCC226 | Hip and Pelvic Fractures | 7.742 | 7.485 | 7.431 | 7.338 | 7.340 |
| HCC228 | Vertebral Fractures without Spinal Cord Injury | 4.007 | 3.844 | 3.742 | 3.608 | 3.582 |
| HCC234 | Traumatic Amputations and Amputation Complications | 4.272 | 4.112 | 4.068 | 3.998 | 3.995 |
| HCC251 | Stem Cell, Including Bone Marrow, Transplant Status/Complications | 17.990 | 18.025 | 18.043 | 18.074 | 18.067 |
| HCC253 | Artificial Openings for Feeding or Elimination | 5.400 | 5.276 | 5.237 | 5.177 | 5.172 |
| HCC254 | Amputation Status, Upper Limb or Lower Limb | 0.923 | 0.828 | 0.775 | 0.708 | 0.699 |
| Interacted HCC Counts Factors | | | | | | |
| | Severe illness, 1 payment HCC | −5.506 | −5.552 | −5.642 | −5.734 | −5.757 |
| | Severe illness, 2 payment HCCs | −5.381 | −5.451 | −5.529 | −5.615 | −5.630 |
| | Severe illness, 3 payment HCCs | −4.624 | −4.683 | −4.671 | −4.664 | −4.645 |
| | Severe illness, 4 payment HCCs | −4.046 | −4.060 | −3.933 | −3.798 | −3.740 |
| | Severe illness, 5 payment HCCs | −3.634 | −3.590 | −3.359 | −3.113 | −3.027 |
| | Severe illness, 6 payment HCCs | −3.188 | −3.063 | −2.734 | −2.385 | −2.275 |
| | Severe illness, 7 payment HCCs | −2.710 | −2.475 | −2.060 | −1.614 | −1.485 |
| | Severe illness, 8 payment HCCs | −2.359 | −2.047 | −1.553 | −1.014 | -0.870 |
| | Severe illness, 9 payment HCCs | −0.965 | −0.515 | 0.053 | 0.682 | 0.839 |
| | Severe illness, 10 or more payment HCCs | 4.976 | 5.806 | 6.546 | 7.415 | 7.608 |
| | Transplant severe illness, 4 payment HCCs | 3.531 | 3.394 | 3.262 | 3.071 | 3.034 |
| | Transplant severe illness, 5 payment HCCs | 6.812 | 6.664 | 6.540 | 6.354 | 6.326 |
| | Transplant severe illness, 6 payment HCCs | 10.112 | 9.960 | 9.839 | 9.656 | 9.631 |
| | Transplant severe illness, 7 payment HCCs | 15.321 | 15.165 | 15.051 | 14.879 | 14.859 |
| | Transplant severe illness, 8 or more payment HCCs | 29.664 | 29.601 | 29.511 | 29.375 | 29.357 |
| Enrollment Duration Factors | | | | | | |
| | Enrolled for 1 month, at least one payment HCC | 11.074 | 9.697 | 8.663 | 7.661 | 7.414 |
| | Enrolled for 2 months, at least one payment HCC | 4.976 | 4.271 | 3.729 | 3.226 | 3.102 |
| | Enrolled for 3 months, at least one payment HCC | 3.206 | 2.743 | 2.369 | 2.026 | 1.944 |
| | Enrolled for 4 months, at least one payment HCC | 1.883 | 1.566 | 1.297 | 1.054 | 0.995 |
| | Enrolled for 5 months, at least one payment HCC | 1.400 | 1.164 | 0.955 | 0.763 | 0.714 |
| | Enrolled for 6 months, at least one payment HCC | 0.936 | 0.762 | 0.599 | 0.448 | 0.407 |
| Affiliated Cost Factors | | | | | | |
| ACF01 | HIV Pre-Exposure Prophylaxis (PrEP) | 3.620 | 3.551 | 3.472 | 3.304 | 3.258 |
| Prescription Drug Factors | | | | | | |
| RXC01 | Anti-HIV Agents | 4.595 | 4.125 | 3.714 | 3.356 | 3.280 |
| RXC02 | Anti-Hepatitis C (HCV) Agents, Direct Acting Agents | 9.107 | 8.614 | 8.476 | 8.335 | 8.361 |
| RXC03 b | Antiarrhythmics | 0.058 | 0.052 | 0.046 | 0.039 | 0.046 |
| RXC04 | Phosphate Binders | 0.868 | 0.993 | 0.785 | 0.988 | 0.917 |
| RXC05 | Inflammatory Bowel Disease Agents | 1.133 | 1.100 | 1.040 | 0.981 | 0.962 |
| RXC06 | Insulin | 1.313 | 1.147 | 0.991 | 0.843 | 0.805 |
| RXC07 | Anti-Diabetic Agents, Except Insulin and Metformin Only | 0.973 | 0.862 | 0.698 | 0.485 | 0.419 |
| RXC08 | Multiple Sclerosis Agents | 12.472 | 11.759 | 11.490 | 11.110 | 11.042 |
| RXC09 | Immune Suppressants and Immunomodulators | 11.545 | 10.994 | 10.921 | 10.759 | 10.777 |
| RXC10 | Cystic Fibrosis Agents | 22.801 | 22.295 | 22.221 | 22.083 | 22.098 |
| RXC01 x HCC001 | Additional effect for enrollees with RXC 01 and HCC 001 | 2.629 | 2.556 | 2.848 | 3.009 | 3.091 |
| RXC02 x HCC0371, 036, 0352, 0351, 034 | Additional effect for enrollees with RXC 02 and (HCC 0371 or 036 or 0352 or 0351 or 034) | -0.516 | -0.455 | -0.396 | -0.336 | -0.325 |
| RXC03 x HCC142 | Additional effect for enrollees with RXC 03 and HCC 142 | 0.000 | 0.000 | 0.000 | 0.000 | 0.000 |
| RXC04 x HCC184, 183, 187, 188 | Additional effect for enrollees with RXC 04 and (HCC 184 or 183 or 187 or 188) | 0.000 | 0.000 | 0.000 | 0.000 | 0.000 |
| RXC05 x HCC048, 041 | Additional effect for enrollees with RXC 05 and (HCC 048 or 041) | −1.106 | −1.087 | −1.040 | −0.981 | −0.962 |
| RXC06 x HCC018, 019, 020, 021 | Additional effect for enrollees with RXC 06 and (HCC 018 or 019 or 020 or 021) | 0.466 | 0.511 | 0.522 | 0.482 | 0.474 |
| RXC07 x HCC018, 019, 020, 021 | Additional effect for enrollees with RXC 07 and (HCC 018 or 019 or 020 or 021) | −0.187 | −0.143 | −0.102 | −0.060 | −0.050 |
| RXC08 x HCC118 | Additional effect for enrollees with RXC 08 and HCC 118 | −0.156 | 0.110 | 0.411 | 0.745 | 0.854 |
| ( printed page 11011) | | | | | | |
| RXC09 x HCC056 or 057 and 048 or 041 | Additional effect for enrollees with RXC 09 and (HCC 048 or 041) and (HCC 056 or 057) | 0.492 | 0.557 | 0.646 | 0.751 | 0.780 |
| RXC09 x HCC056 | Additional effect for enrollees with RXC 09 and HCC 056 | −1.363 | −1.259 | −1.188 | −1.104 | −1.086 |
| RXC09 x HCC057 | Additional effect for enrollees with RXC 09 and HCC 057 | −0.355 | −0.286 | −0.198 | −0.098 | −0.069 |
| RXC09 x HCC048, 041 | Additional effect for enrollees with RXC 09 and (HCC 048 or 041) | −1.901 | −1.802 | −1.748 | −1.670 | −1.651 |
| RXC10 x HCC159, 158 | Additional effect for enrollees with RXC 10 and (HCC 159 or 158) | 36.448 | 36.460 | 36.625 | 36.751 | 36.785 |
| a HCC numbers that appear with an underscore in this document will appear without the underscore in the “Do It Yourself (DIY)” software. For example, HCC 35_1 in this table will appear as HCC 351 in the DIY software. | | | | | | |
| b We constrain RXC 03 to be equal to average plan liability for RXC 03 drugs, RXC 04 to be equal to the average plan liability for RXC 04 drugs, and we constrain RXC 03 x HCC142 and RXC 04 x HCC184, 183, 187, 188 to be equal to zero. See March 2016 Risk Adjustment Methodology Discussion Paper (2016 March, 16), available at: https://www.cms.gov/​cciio/​resources/​forms-reports-and-other-resources/​downloads/​ra-march-31-white-paper-032416.pdf (where we previously discussed the use of constraints in the HHS risk adjustment models). | | | | | | |
2. On pages 6313 through 6316, the table titled “TABLE 2: Proposed Child Risk Adjustment Model Factors for the 2027 Benefit Year” is corrected to read as follows:

| Factor | Platinum | Gold | Silver | Bronze | Catastrophic |
| --- | --- | --- | --- | --- | --- |
| Demographic Factors | | | | | |
| Age 2-4, Male | 0.297 | 0.217 | 0.162 | 0.118 | 0.106 |
| Age 5-9, Male | 0.222 | 0.154 | 0.113 | 0.085 | 0.077 |
| Age 10-14, Male | 0.210 | 0.146 | 0.108 | 0.082 | 0.076 |
| Age 15-20, Male | 0.246 | 0.179 | 0.132 | 0.097 | 0.088 |
| Age 2-4, Female | 0.237 | 0.166 | 0.124 | 0.092 | 0.084 |
| Age 5-9, Female | 0.162 | 0.102 | 0.067 | 0.044 | 0.039 |
| Age 10-14, Female | 0.216 | 0.153 | 0.115 | 0.089 | 0.082 |
| Age 15-20, Female | 0.267 | 0.187 | 0.124 | 0.077 | 0.063 |
| Diagnosis Factors | | | | | |
| HIV/AIDS | 4.494 | 4.068 | 3.903 | 3.679 | 3.658 |
| Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock | 14.480 | 14.282 | 14.169 | 14.032 | 14.013 |
| Central Nervous System Infections, Except Viral Meningitis | 14.430 | 14.273 | 14.207 | 14.113 | 14.097 |
| Viral or Unspecified Meningitis | 12.991 | 12.869 | 12.785 | 12.679 | 12.655 |
| Opportunistic Infections | 20.233 | 20.191 | 20.119 | 20.039 | 20.013 |
| Metastatic Cancer | 31.479 | 31.228 | 31.163 | 31.056 | 31.045 |
| Lung, Brain, and Other Severe Cancers, Including Pediatric Acute Lymphoid Leukemia | 9.613 | 9.381 | 9.254 | 9.091 | 9.059 |
| Non-Hodgkin Lymphomas and Other Cancers and Tumors | 8.609 | 8.408 | 8.278 | 8.118 | 8.083 |
| Colorectal, Breast (Age <50), Kidney, and Other Cancers | 3.753 | 3.604 | 3.500 | 3.366 | 3.332 |
| Breast (Age 50+) and Prostate Cancer, Benign/Uncertain Brain Tumors, and Other Cancers and Tumors | 3.753 | 3.604 | 3.500 | 3.366 | 3.332 |
| Thyroid Cancer, Melanoma, Neurofibromatosis, and Other Cancers and Tumors | 1.204 | 1.092 | 0.978 | 0.855 | 0.818 |
| Pancreas Transplant Status | 11.308 | 11.349 | 11.403 | 11.462 | 11.475 |
| Diabetes with Acute Complications | 2.107 | 1.904 | 1.613 | 1.264 | 1.175 |
| Diabetes with Chronic Complications | 2.107 | 1.904 | 1.613 | 1.264 | 1.175 |
| Diabetes without Complication | 2.107 | 1.904 | 1.613 | 1.264 | 1.175 |
| Protein-Calorie Malnutrition | 17.913 | 17.788 | 17.745 | 17.685 | 17.674 |
| Mucopolysaccharidosis | 27.455 | 27.228 | 27.158 | 27.051 | 27.042 |
| Lipidoses and Glycogenosis | 27.455 | 27.228 | 27.158 | 27.051 | 27.042 |
| Congenital Metabolic Disorders, Not Elsewhere Classified | 4.860 | 4.741 | 4.671 | 4.584 | 4.566 |
| Amyloidosis, Porphyria, and Other Metabolic Disorders | 4.860 | 4.741 | 4.671 | 4.584 | 4.566 |
| Adrenal, Pituitary, and Other Significant Endocrine Disorders | 4.585 | 4.353 | 4.263 | 4.148 | 4.135 |
| Liver Transplant Status/Complications | 11.308 | 11.349 | 11.403 | 11.462 | 11.475 |
| Acute Liver Failure/Disease, Including Neonatal Hepatitis | 12.753 | 12.612 | 12.564 | 12.499 | 12.492 |
| Chronic Liver Failure/End-Stage Liver Disorders | 8.744 | 8.588 | 8.509 | 8.401 | 8.379 |
| Cirrhosis of Liver | 2.077 | 1.972 | 1.888 | 1.798 | 1.778 |
| Chronic Viral Hepatitis C | 2.077 | 1.972 | 1.888 | 1.798 | 1.778 |
| Chronic Hepatitis, Except Chronic Viral Hepatitis C | 1.367 | 1.287 | 1.195 | 1.098 | 1.073 |
| Intestine Transplant Status/Complications | 15.155 | 15.082 | 15.015 | 14.930 | 14.907 |
| Peritonitis/Gastrointestinal Perforation/Necrotizing Enterocolitis | 17.893 | 17.607 | 17.538 | 17.427 | 17.422 |
| Intestinal Obstruction | 3.920 | 3.746 | 3.616 | 3.458 | 3.423 |
| ( printed page 11012) | | | | | |
| Chronic Pancreatitis | 9.814 | 9.635 | 9.554 | 9.449 | 9.434 |
| Acute Pancreatitis | 6.643 | 6.415 | 6.272 | 6.089 | 6.054 |
| Inflammatory Bowel Disease | 10.636 | 10.225 | 10.089 | 9.880 | 9.859 |
| Necrotizing Fasciitis | 4.686 | 4.490 | 4.367 | 4.224 | 4.197 |
| Bone/Joint/Muscle Infections/Necrosis | 4.686 | 4.490 | 4.367 | 4.224 | 4.197 |
| Rheumatoid Arthritis and Specified Autoimmune Disorders | 4.802 | 4.534 | 4.429 | 4.288 | 4.270 |
| Systemic Lupus Erythematosus and Other Autoimmune Disorders | 1.211 | 1.106 | 1.002 | 0.884 | 0.852 |
| Osteogenesis Imperfecta and Other Osteodystrophies | 1.112 | 1.008 | 0.919 | 0.822 | 0.799 |
| Congenital/Developmental Skeletal and Connective Tissue Disorders | 1.112 | 1.008 | 0.919 | 0.822 | 0.799 |
| Cleft Lip/Cleft Palate | 0.852 | 0.729 | 0.606 | 0.470 | 0.433 |
| Hemophilia | 59.554 | 59.072 | 58.973 | 58.779 | 58.763 |
| Myelodysplastic Syndromes and Myelofibrosis | 11.606 | 11.431 | 11.349 | 11.244 | 11.231 |
| Aplastic Anemia | 11.606 | 11.431 | 11.349 | 11.244 | 11.231 |
| Acquired Hemolytic Anemia, Including Hemolytic Disease of Newborn | 11.606 | 11.431 | 11.349 | 11.244 | 11.231 |
| Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero | 3.359 | 3.193 | 3.083 | 2.958 | 2.929 |
| Sickle-Cell Disorders, Except Sickle-Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major | 3.359 | 3.193 | 3.083 | 2.958 | 2.929 |
| Combined and Other Severe Immunodeficiencies | 5.693 | 5.547 | 5.470 | 5.368 | 5.350 |
| Disorders of the Immune Mechanism | 5.693 | 5.547 | 5.470 | 5.368 | 5.350 |
| Coagulation Defects and Other Specified Hematological Disorders | 4.135 | 4.022 | 3.937 | 3.839 | 3.817 |
| Drug Use with Psychotic Complications | 2.239 | 2.101 | 1.978 | 1.833 | 1.799 |
| Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications | 2.239 | 2.101 | 1.978 | 1.833 | 1.799 |
| Alcohol Use with Psychotic Complications | 0.811 | 0.683 | 0.540 | 0.377 | 0.338 |
| Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications | 0.811 | 0.683 | 0.540 | 0.377 | 0.338 |
| Schizophrenia | 3.875 | 3.617 | 3.437 | 3.224 | 3.185 |
| Delusional and Other Specified Psychotic Disorders, Unspecified Psychosis | 3.273 | 3.038 | 2.852 | 2.625 | 2.575 |
| Major Depressive Disorder, Severe, and Bipolar Disorders | 2.710 | 2.509 | 2.352 | 2.169 | 2.126 |
| Personality Disorders | 0.597 | 0.513 | 0.416 | 0.311 | 0.277 |
| Anorexia/Bulimia Nervosa | 2.132 | 1.994 | 1.886 | 1.751 | 1.717 |
| Prader-Willi, Patau, Edwards, and Autosomal Deletion Syndromes | 12.106 | 12.042 | 12.004 | 11.952 | 11.938 |
| Down Syndrome, Fragile X, Other Chromosomal Anomalies, and Congenital Malformation Syndromes | 0.799 | 0.693 | 0.601 | 0.491 | 0.463 |
| Autistic Disorder | 2.710 | 2.509 | 2.352 | 2.169 | 2.126 |
| Pervasive Developmental Disorders, Except Autistic Disorder | 0.597 | 0.513 | 0.416 | 0.321 | 0.297 |
| Traumatic Complete Lesion Cervical Spinal Cord | 10.342 | 10.139 | 10.066 | 9.954 | 9.944 |
| Quadriplegia | 10.342 | 10.139 | 10.066 | 9.954 | 9.944 |
| Traumatic Complete Lesion Dorsal Spinal Cord | 7.706 | 7.483 | 7.370 | 7.223 | 7.201 |
| Paraplegia | 7.706 | 7.483 | 7.370 | 7.223 | 7.201 |
| Spinal Cord Disorders/Injuries | 4.354 | 4.171 | 4.045 | 3.880 | 3.841 |
| Amyotrophic Lateral Sclerosis and Other Anterior Horn Cell Disease | 44.922 | 44.615 | 44.563 | 44.454 | 44.447 |
| Quadriplegic Cerebral Palsy | 1.301 | 1.125 | 1.017 | 0.881 | 0.861 |
| Cerebral Palsy, Except Quadriplegic | 0.394 | 0.278 | 0.202 | 0.113 | 0.091 |
| Spina Bifida and Other Brain/Spinal/Nervous System Congenital Anomalies | 1.403 | 1.295 | 1.208 | 1.102 | 1.078 |
| Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy | 11.196 | 11.067 | 11.035 | 10.986 | 10.988 |
| Muscular Dystrophy | 6.335 | 6.182 | 6.087 | 5.966 | 5.942 |
| Multiple Sclerosis | 7.535 | 7.183 | 7.067 | 6.898 | 6.885 |
| Parkinson's, Huntington's, and Spinocerebellar Disease, and Other Neurodegenerative Disorders | 6.335 | 6.182 | 6.087 | 5.966 | 5.942 |
| Seizure Disorders and Convulsions | 1.519 | 1.389 | 1.256 | 1.104 | 1.063 |
| Hydrocephalus | 11.643 | 11.592 | 11.599 | 11.603 | 11.602 |
| Nontraumatic Coma, Except Diabetic, Hepatic, or Hypoglycemic; Nontraumatic Brain Compression/Anoxic Damage | 11.490 | 11.480 | 11.484 | 11.487 | 11.485 |
| Narcolepsy and Cataplexy | 3.550 | 3.402 | 3.296 | 3.156 | 3.115 |
| Respirator Dependence/Tracheostomy Status | 26.852 | 26.609 | 26.531 | 26.418 | 26.408 |
| Respiratory Arrest | 15.129 | 14.889 | 14.754 | 14.581 | 14.559 |
| Cardio-Respiratory Failure and Shock, Including Respiratory Distress Syndromes | 15.129 | 14.889 | 14.754 | 14.581 | 14.559 |
| Heart Assistive Device/Artificial Heart | 15.155 | 15.082 | 15.015 | 14.930 | 14.907 |
| Heart Transplant Status/Complications | 15.155 | 15.082 | 15.015 | 14.930 | 14.907 |
| Heart Failure | 3.656 | 3.549 | 3.481 | 3.391 | 3.370 |
| Acute Myocardial Infarction | 0.225 | 0.196 | 0.157 | 0.107 | 0.088 |
| Unstable Angina and Other Acute Ischemic Heart Disease | 0.225 | 0.196 | 0.157 | 0.107 | 0.088 |
| Heart Infection/Inflammation, Except Rheumatic | 15.433 | 15.322 | 15.236 | 15.136 | 15.111 |
| Hypoplastic Left Heart Syndrome and Other Severe Congenital Heart Disorders | 3.711 | 3.564 | 3.444 | 3.307 | 3.273 |
| Major Congenital Heart/Circulatory Disorders | 0.962 | 0.862 | 0.757 | 0.652 | 0.624 |
| ( printed page 11013) | | | | | |
| Atrial and Ventricular Septal Defects, Patent Ductus Arteriosus, and Other Congenital Heart/Circulatory Disorders | 0.525 | 0.439 | 0.352 | 0.268 | 0.248 |
| Specified Heart Arrhythmias | 3.136 | 2.983 | 2.882 | 2.759 | 2.732 |
| Intracranial Hemorrhage | 12.158 | 12.048 | 12.010 | 11.963 | 11.955 |
| Ischemic or Unspecified Stroke | 0.531 | 0.420 | 0.353 | 0.272 | 0.255 |
| Cerebral Aneurysm and Arteriovenous Malformation | 0.813 | 0.690 | 0.607 | 0.502 | 0.480 |
| Hemiplegia/Hemiparesis | 4.230 | 4.089 | 3.989 | 3.861 | 3.834 |
| Monoplegia, Other Paralytic Syndromes | 2.776 | 2.633 | 2.537 | 2.417 | 2.392 |
| Atherosclerosis of the Extremities with Ulceration or Gangrene | 10.094 | 9.865 | 9.741 | 9.588 | 9.568 |
| Vascular Disease with Complications | 12.595 | 12.449 | 12.389 | 12.300 | 12.286 |
| Pulmonary Embolism and Deep Vein Thrombosis | 19.285 | 19.147 | 19.070 | 18.968 | 18.947 |
| Lung Transplant Status/Complications | 15.155 | 15.082 | 15.015 | 14.930 | 14.907 |
| Cystic Fibrosis | 49.902 | 49.319 | 49.258 | 49.095 | 49.105 |
| Chronic Obstructive Pulmonary Disease, Including Bronchiectasis | 1.825 | 1.669 | 1.534 | 1.379 | 1.342 |
| Severe Asthma | 1.253 | 1.093 | 0.929 | 0.748 | 0.704 |
| Asthma, Except Severe | 0.323 | 0.248 | 0.165 | 0.092 | 0.072 |
| Fibrosis of Lung and Other Lung Disorders | 1.444 | 1.329 | 1.211 | 1.083 | 1.051 |
| Aspiration and Specified Bacterial Pneumonias and Other Severe Lung Infections | 11.365 | 11.349 | 11.403 | 11.462 | 11.475 |
| Kidney Transplant Status/Complications | 11.308 | 11.349 | 11.403 | 11.462 | 11.475 |
| End Stage Renal Disease | 23.942 | 23.682 | 23.657 | 23.578 | 23.576 |
| Chronic Kidney Disease, Stage 5 | 2.630 | 2.522 | 2.430 | 2.344 | 2.325 |
| Chronic Kidney Disease, Severe (Stage 4) | 2.630 | 2.522 | 2.430 | 2.344 | 2.325 |
| Ectopic and Molar Pregnancy | 0.988 | 0.833 | 0.642 | 0.431 | 0.386 |
| Miscarriage with Complications | 0.526 | 0.409 | 0.233 | 0.036 | 0.005 |
| Miscarriage with No or Minor Complications | 0.526 | 0.409 | 0.233 | 0.036 | 0.005 |
| Pregnancy with Delivery with Major Complications | 3.019 | 2.757 | 2.391 | 1.934 | 1.805 |
| Pregnancy with Delivery with Complications | 3.019 | 2.757 | 2.391 | 1.934 | 1.805 |
| Pregnancy with Delivery with No or Minor Complications | 2.183 | 1.972 | 1.629 | 1.180 | 1.023 |
| (Ongoing) Pregnancy without Delivery with Major Complications | 0.513 | 0.378 | 0.189 | 0.011 | 0.000 |
| (Ongoing) Pregnancy without Delivery with Complications | 0.513 | 0.378 | 0.189 | 0.011 | 0.000 |
| (Ongoing) Pregnancy without Delivery with No or Minor Complications | 0.284 | 0.182 | 0.068 | 0.000 | 0.000 |
| Chronic Ulcer of Skin, Except Pressure | 2.113 | 2.020 | 1.939 | 1.855 | 1.833 |
| Extensive Third Degree Burns | 22.256 | 22.021 | 21.922 | 21.792 | 21.772 |
| Major Skin Burn or Condition | 2.590 | 2.420 | 2.281 | 2.120 | 2.083 |
| Severe Head Injury | 22.256 | 22.021 | 21.922 | 21.792 | 21.772 |
| Hip and Pelvic Fractures | 4.114 | 3.906 | 3.772 | 3.623 | 3.596 |
| Vertebral Fractures without Spinal Cord Injury | 4.144 | 3.952 | 3.811 | 3.639 | 3.600 |
| Traumatic Amputations and Amputation Complications | 3.694 | 3.520 | 3.372 | 3.192 | 3.147 |
| Stem Cell, Including Bone Marrow, Transplant Status/Complications | 15.155 | 15.082 | 15.015 | 14.930 | 14.907 |
| Artificial Openings for Feeding or Elimination | 4.495 | 4.323 | 4.257 | 4.161 | 4.151 |
| Amputation Status, Upper Limb or Lower Limb | 3.694 | 3.520 | 3.372 | 3.192 | 3.147 |
| Interacted HCC Counts Factors | | | | | |
| Severe illness, 1 payment HCC | −11.308 | −11.349 | −11.403 | −11.462 | −11.475 |
| Severe illness, 2 payment HCCs | −11.308 | −11.349 | −11.403 | −11.462 | −11.475 |
| Severe illness, 3 payment HCCs | −10.149 | −10.211 | −10.174 | −10.162 | −10.141 |
| Severe illness, 4 payment HCCs | −9.055 | −9.082 | −8.919 | −8.762 | −8.697 |
| Severe illness, 5 payment HCCs | −8.454 | −8.416 | −8.172 | −7.938 | −7.853 |
| Severe illness, 6 or 7 payment HCCs | −4.190 | −3.978 | −3.561 | −3.133 | −3.003 |
| Severe illness, 8 or more payment HCCs | 18.133 | 18.860 | 19.604 | 20.422 | 20.625 |
| Transplant severe illness, 4 or more payment HCCs | 15.299 | 15.306 | 15.287 | 15.271 | 15.267 |
| Affiliated Cost Factors | | | | | |
| HIV Pre-Exposure Prophylaxis (PrEP) | 2.089 | 2.042 | 1.984 | 1.923 | 1.905 |
3. On page 6317, the table titled “TABLE 3: HHS HCCs Selected for the HCC Interacted Counts Variables for the Adult and Child Models for the 2027 Benefit Year” is corrected to read as follows:

| Payment HCC | Severity illness
indicator | Transplant
indicator |
| --- | --- | --- |
| HCC 2 Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock | X | |
| HCC 3 Central Nervous System Infections, Except Viral Meningitis | X | |
| ( printed page 11014) | | |
| HCC 4 Viral or Unspecified Meningitis | X | |
| HCC 6 Opportunistic Infections | X | |
| HCC 23 Protein-Calorie Malnutrition | X | |
| HCC 34 Liver Transplant Status/Complications | X | X |
| HCC 41 Intestine Transplant Status/Complications | X | X |
| HCC 42 Peritonitis/Gastrointestinal Perforation/Necrotizing Enterocolitis | X | |
| HCC 96 Prader-Willi, Patau, Edwards, and Autosomal Deletion Syndromes | X | |
| HCC 121 Hydrocephalus | X | |
| HCC 122 Nontraumatic Coma, Except Diabetic, Hepatic, or Hypoglycemic; Nontraumatic Brain Compression/Anoxic Damage | X | |
| HCC 125 Respirator Dependence/Tracheostomy Status | X | |
| HCC 135 Heart Infection/Inflammation, Except Rheumatic | X | |
| HCC 145 Intracranial Hemorrhage | X | |
| HCC 156 Pulmonary Embolism and Deep Vein Thrombosis | X | |
| HCC 158 Lung Transplant Status/Complications | X | X |
| HCC 163 Aspiration and Specified Bacterial Pneumonias and Other Severe Lung Infections | X | |
| HCC 218 Extensive Third Degree Burns | X | |
| HCC 223 Severe Head Injury | X | |
| HCC 251 Stem Cell, Including Bone Marrow, Transplant Status/Complications | X | X |
| G13 (Includes HCC 126 Respiratory Arrest and HCC 127 Cardio-Respiratory Failure and Shock, Including Respiratory Distress Syndromes) | X | |
| G14 (Includes HCC 128 Heart Assistive Device/Artificial Heart and HCC 129 Heart Transplant Status/Complications) | X | X |
| G24 (Includes HCC 18 Pancreas Transplant Status and HCC 183 Kidney Transplant Status/Complications) | X | X |
4. On page 6318, top half of the page, the table titled “TABLE 4: Proposed Infant Risk Adjustment Model Factors for the 2027 Benefit Year” is corrected to read as follows:

| Group | Platinum | Gold | Silver | Bronze | Catastrophic |
| --- | --- | --- | --- | --- | --- |
| Extremely Immature * Severity Level 5 (Highest) | 197.671 | 196.159 | 195.801 | 195.221 | 195.198 |
| Extremely Immature * Severity Level 4 | 129.748 | 128.048 | 127.479 | 126.693 | 126.619 |
| Extremely Immature * Severity Level 3 | 29.087 | 27.703 | 27.191 | 26.528 | 26.453 |
| Extremely Immature * Severity Level 2 | 29.087 | 27.703 | 27.191 | 26.528 | 26.453 |
| Extremely Immature * Severity Level 1 (Lowest) | 29.087 | 27.703 | 27.191 | 26.528 | 26.453 |
| Immature * Severity Level 5 (Highest) | 123.452 | 121.973 | 121.649 | 121.124 | 121.107 |
| Immature * Severity Level 4 | 67.497 | 65.845 | 65.420 | 64.760 | 64.712 |
| Immature * Severity Level 3 | 29.087 | 27.703 | 27.191 | 26.528 | 26.453 |
| Immature * Severity Level 2 | 22.383 | 21.155 | 20.619 | 19.967 | 19.876 |
| Immature * Severity Level 1 (Lowest) | 21.881 | 20.636 | 20.094 | 19.436 | 19.346 |
| Premature/Multiples * Severity Level 5 (Highest) | 107.440 | 105.978 | 105.584 | 105.002 | 104.960 |
| Premature/Multiples * Severity Level 4 | 27.962 | 26.600 | 26.069 | 25.389 | 25.317 |
| Premature/Multiples * Severity Level 3 | 12.192 | 11.287 | 10.647 | 9.906 | 9.741 |
| Premature/Multiples * Severity Level 2 | 7.667 | 6.967 | 6.351 | 5.654 | 5.480 |
| Premature/Multiples * Severity Level 1 (Lowest) | 5.481 | 4.884 | 4.306 | 3.679 | 3.503 |
| Term * Severity Level 5 (Highest) | 80.094 | 78.884 | 78.453 | 77.860 | 77.791 |
| Term * Severity Level 4 | 16.487 | 15.512 | 14.880 | 14.150 | 14.017 |
| Term * Severity Level 3 | 5.490 | 4.920 | 4.339 | 3.704 | 3.528 |
| Term * Severity Level 2 | 3.764 | 3.279 | 2.717 | 2.108 | 1.931 |
| Term * Severity Level 1 (Lowest) | 2.081 | 1.689 | 1.247 | 0.869 | 0.778 |
| Age1 * Severity Level 5 (Highest) | 69.546 | 68.851 | 68.623 | 68.313 | 68.286 |
| Age1 * Severity Level 4 | 12.005 | 11.504 | 11.187 | 10.827 | 10.759 |
| Age1 * Severity Level 3 | 2.842 | 2.580 | 2.365 | 2.151 | 2.097 |
| Age1 * Severity Level 2 | 1.802 | 1.576 | 1.352 | 1.132 | 1.070 |
| Age1 * Severity Level 1 (Lowest) | 0.569 | 0.478 | 0.421 | 0.380 | 0.368 |
| Age 0 Male | 0.498 | 0.460 | 0.421 | 0.360 | 0.340 |
| Age 1 Male | 0.067 | 0.052 | 0.032 | 0.011 | 0.007 |
5. On page 6318, bottom half of the page, the table titled “TABLE 5: HHS HCCs Included in Infant Model Maturity Categories” is corrected to read as follows: ( printed page 11015)

| Maturity category | HCC/description |
| --- | --- |
| Extremely Immature | Extremely Immature Newborns, Birth weight <500 Grams. |
| Extremely Immature | Extremely Immature Newborns, Including Birth weight 500-749 Grams. |
| Extremely Immature | Extremely Immature Newborns, Including Birth weight 750-999 Grams. |
| Immature | Premature Newborns, Including Birth weight 1000-1499 Grams. |
| Immature | Premature Newborns, Including Birth weight 1500-1999 Grams. |
| Premature/Multiples | Premature Newborns, Including Birth weight 2000-2499 Grams. |
| Premature/Multiples | Other Premature, Low Birth weight, Malnourished, or Multiple Birth Newborns. |
| Term | Term or Post-Term Singleton Newborn, Normal or High Birth weight. |
| Age 1 | All age 1 infants. |
6. On page 6319 through the top half of page 6321, the table titled “TABLE 6: HHS HCCs Included in Infant Model Severity Categories” is corrected to read as follows:

| Severity category | HCC/description |
| --- | --- |
| Severity Level 5 (Highest) | Metastatic Cancer. |
| Severity Level 5 | Pancreas Transplant Status. |
| Severity Level 5 | Liver Transplant Status/Complications. |
| Severity Level 5 | Intestine Transplant Status/Complications. |
| Severity Level 5 | Peritonitis/Gastrointestinal Perforation/Necrotizing Enterocolitis. |
| Severity Level 5 | Respirator Dependence/Tracheostomy Status. |
| Severity Level 5 | Heart Assistive Device/Artificial Heart. |
| Severity Level 5 | Heart Transplant Status/Complications. |
| Severity Level 5 | Heart Failure. |
| Severity Level 5 | Hypoplastic Left Heart Syndrome and Other Severe Congenital Heart Disorders. |
| Severity Level 5 | Lung Transplant Status/Complications. |
| Severity Level 5 | Kidney Transplant Status/Complications. |
| Severity Level 5 | End Stage Renal Disease. |
| Severity Level 5 | Stem Cell, Including Bone Marrow, Transplant Status/Complications. |
| Severity Level 4 | Septicemia, Sepsis, Systemic Inflammatory Response Syndrome/Shock. |
| Severity Level 4 | Lung, Brain, and Other Severe Cancers, Including Pediatric Acute Lymphoid Leukemia. |
| Severity Level 4 | Mucopolysaccharidosis. |
| Severity Level 4 | Adrenal, Pituitary, and Other Significant Endocrine Disorders. |
| Severity Level 4 | Acute Liver Failure/Disease, Including Neonatal Hepatitis. |
| Severity Level 4 | Chronic Liver Failure/End-Stage Liver Disorders. |
| Severity Level 4 | Major Congenital Anomalies of Diaphragm, Abdominal Wall, and Esophagus, Age <2. |
| Severity Level 4 | Myelodysplastic Syndromes and Myelofibrosis. |
| Severity Level 4 | Aplastic Anemia. |
| Severity Level 4 | Combined and Other Severe Immunodeficiencies. |
| Severity Level 4 | Traumatic Complete Lesion Cervical Spinal Cord. |
| Severity Level 4 | Quadriplegia. |
| Severity Level 4 | Amyotrophic Lateral Sclerosis and Other Anterior Horn Cell Disease. |
| Severity Level 4 | Quadriplegic Cerebral Palsy. |
| Severity Level 4 | Myasthenia Gravis/Myoneural Disorders and Guillain-Barre Syndrome/Inflammatory and Toxic Neuropathy. |
| Severity Level 4 | Nontraumatic Coma, Except Diabetic, Hepatic, or Hypoglycemic; Nontraumatic Brain Compression/Anoxic Damage. |
| Severity Level 4 | Respiratory Arrest. |
| Severity Level 4 | Cardio-Respiratory Failure and Shock, Including Respiratory Distress Syndromes. |
| Severity Level 4 | Acute Myocardial Infarction. |
| Severity Level 4 | Heart Infection/Inflammation, Except Rheumatic. |
| Severity Level 4 | Major Congenital Heart/Circulatory Disorders. |
| Severity Level 4 | Intracranial Hemorrhage. |
| Severity Level 4 | Ischemic or Unspecified Stroke. |
| Severity Level 4 | Vascular Disease with Complications. |
| Severity Level 4 | Pulmonary Embolism and Deep Vein Thrombosis. |
| Severity Level 4 | Aspiration and Specified Bacterial Pneumonias and Other Severe Lung Infections. |
| Severity Level 4 | Chronic Kidney Disease, Stage 5. |
| Severity Level 4 | Artificial Openings for Feeding or Elimination. |
| Severity Level 3 | HIV/AIDS. |
| Severity Level 3 | Central Nervous System Infections, Except Viral Meningitis. |
| Severity Level 3 | Opportunistic Infections. |
| Severity Level 3 | Non-Hodgkin Lymphomas and Other Cancers and Tumors. |
| Severity Level 3 | Colorectal, Breast (Age <50), Kidney, and Other Cancers. |
| Severity Level 3 | Breast (Age 50+) and Prostate Cancer, Benign/Uncertain Brain Tumors, and Other Cancers and Tumors. |
| Severity Level 3 | Lipidoses and Glycogenosis. |
| Severity Level 3 | Intestinal Obstruction. |
| Severity Level 3 | Necrotizing Fasciitis. |
| Severity Level 3 | Bone/Joint/Muscle Infections/Necrosis. |
| ( printed page 11016) | |
| Severity Level 3 | Osteogenesis Imperfecta and Other Osteodystrophies. |
| Severity Level 3 | Cleft Lip/Cleft Palate. |
| Severity Level 3 | Hemophilia. |
| Severity Level 3 | Sickle Cell Anemia (Hb-SS) and Thalassemia Beta Zero. |
| Severity Level 3 | Disorders of the Immune Mechanism. |
| Severity Level 3 | Coagulation Defects and Other Specified Hematological Disorders. |
| Severity Level 3 | Drug Use with Psychotic Complications. |
| Severity Level 3 | Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications. |
| Severity Level 3 | Alcohol Use with Psychotic Complications. |
| Severity Level 3 | Alcohol Use Disorder, Moderate/Severe, or Alcohol Use with Specified Non-Psychotic Complications. |
| Severity Level 3 | Prader-Willi, Patau, Edwards, and Autosomal Deletion Syndromes. |
| Severity Level 3 | Traumatic Complete Lesion Dorsal Spinal Cord. |
| Severity Level 3 | Paraplegia. |
| Severity Level 3 | Spinal Cord Disorders/Injuries. |
| Severity Level 3 | Cerebral Palsy, Except Quadriplegic. |
| Severity Level 3 | Spina Bifida and Other Brain/Spinal/Nervous System Congenital Anomalies. |
| Severity Level 3 | Muscular Dystrophy. |
| Severity Level 3 | Parkinson's, Huntington's, and Spinocerebellar Disease, and Other Neurodegenerative Disorders. |
| Severity Level 3 | Hydrocephalus. |
| Severity Level 3 | Unstable Angina and Other Acute Ischemic Heart Disease. |
| Severity Level 3 | Atrial and Ventricular Septal Defects, Patent Ductus Arteriosus, and Other Congenital Heart/Circulatory Disorders. |
| Severity Level 3 | Specified Heart Arrhythmias. |
| Severity Level 3 | Cerebral Aneurysm and Arteriovenous Malformation. |
| Severity Level 3 | Hemiplegia/Hemiparesis. |
| Severity Level 3 | Cystic Fibrosis. |
| Severity Level 3 | Extensive Third Degree Burns. |
| Severity Level 3 | Severe Head Injury. |
| Severity Level 3 | Hip and Pelvic Fractures. |
| Severity Level 3 | Vertebral Fractures without Spinal Cord Injury. |
| Severity Level 2 | Viral or Unspecified Meningitis. |
| Severity Level 2 | Thyroid Cancer, Melanoma, Neurofibromatosis, and Other Cancers and Tumors. |
| Severity Level 2 | Diabetes with Acute Complications. |
| Severity Level 2 | Diabetes with Chronic Complications. |
| Severity Level 2 | Diabetes without Complication. |
| Severity Level 2 | Protein-Calorie Malnutrition. |
| Severity Level 2 | Congenital Metabolic Disorders, Not Elsewhere Classified. |
| Severity Level 2 | Amyloidosis, Porphyria, and Other Metabolic Disorders. |
| Severity Level 2 | Cirrhosis of Liver. |
| Severity Level 2 | Chronic Pancreatitis. |
| Severity Level 2 | Acute Pancreatitis. |
| Severity Level 2 | Inflammatory Bowel Disease. |
| Severity Level 2 | Rheumatoid Arthritis and Specified Autoimmune Disorders. |
| Severity Level 2 | Systemic Lupus Erythematosus and Other Autoimmune Disorders. |
| Severity Level 2 | Congenital/Developmental Skeletal and Connective Tissue Disorders. |
| Severity Level 2 | Acquired Hemolytic Anemia, Including Hemolytic Disease of Newborn. |
| Severity Level 2 | Sickle-Cell Disorders, Except Sickle-Cell Anemia (Hb-SS) and Thalassemia Beta Zero; Beta Thalassemia Major. |
| Severity Level 2 | Down Syndrome, Fragile X, Other Chromosomal Anomalies, and Congenital Malformation Syndromes. |
| Severity Level 2 | Seizure Disorders and Convulsions. |
| Severity Level 2 | Monoplegia, Other Paralytic Syndromes. |
| Severity Level 2 | Atherosclerosis of the Extremities with Ulceration or Gangrene. |
| Severity Level 2 | Chronic Obstructive Pulmonary Disease, Including Bronchiectasis. |
| Severity Level 2 | Severe Asthma. |
| Severity Level 2 | Fibrosis of Lung and Other Lung Disorders. |
| Severity Level 2 | Chronic Kidney Disease, Severe (Stage 4). |
| Severity Level 2 | Chronic Ulcer of Skin, Except Pressure. |
| Severity Level 2 | Major Skin Burn or Condition. |
| Severity Level 1 (Lowest) | Chronic Viral Hepatitis C. |
| Severity Level 1 | Chronic Hepatitis, Except Chronic Viral Hepatitis C. |
| Severity Level 1 | Autistic Disorder. |
| Severity Level 1 | Pervasive Developmental Disorders, Except Autistic Disorder. |
| Severity Level 1 | Multiple Sclerosis. |
| Severity Level 1 | Asthma, Except Severe. |
| Severity Level 1 | Traumatic Amputations and Amputation Complications. |
| Severity Level 1 | Amputation Status, Upper Limb or Lower Limb. |
7. On page 6321, bottom half of the page, the table titled “TABLE 7: R-Squared Statistics for Proposed 2027 Benefit Year HHS Risk Adjustment Models” is corrected to read as follows: ( printed page 11017)

| Model | BY2021
Enrollee-level
EDGE data | BY2022
Enrollee-level
EDGE data | BY2023
Enrollee-level
EDGE data |
| --- | --- | --- | --- |
| Platinum Adult | 0.4213 | 0.4094 | 0.4152 |
| Gold Adult | 0.4154 | 0.4032 | 0.4089 |
| Silver Adult | 0.4122 | 0.3996 | 0.4048 |
| Bronze Adult | 0.4077 | 0.3948 | 0.3996 |
| Catastrophic Adult | 0.4068 | 0.3937 | 0.3982 |
| Platinum Child | 0.3569 | 0.3639 | 0.3412 |
| Gold Child | 0.3540 | 0.3612 | 0.3381 |
| Silver Child | 0.3516 | 0.3588 | 0.3357 |
| Bronze Child | 0.3484 | 0.3555 | 0.3324 |
| Catastrophic Child | 0.3474 | 0.3545 | 0.3314 |
| Platinum Infant | 0.3099 | 0.2883 | 0.2727 |
| Gold Infant | 0.3062 | 0.2847 | 0.2687 |
| Silver Infant | 0.3044 | 0.2827 | 0.2667 |
| Bronze Infant | 0.3019 | 0.2802 | 0.2640 |
| Catastrophic Infant | 0.3014 | 0.2797 | 0.2635 |
Liesl I. Fowler,

Executive Secretary to the Department, Department of Health and Human Services.

[FR Doc. 2026-04467 Filed 3-5-26; 8:45 am]

BILLING CODE 4120-01-P

Published Document: 2026-04467 (91 FR 11006)