Skip to content

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

Open
@sarah-tuva

Description


Describe the bug - Required
A clear and concise description of what the bug is.

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

To Reproduce
Steps to reproduce the behavior:

  1. Go to '...'
  2. Click on '....'
  3. Scroll down to '....'
  4. See error

Expected behavior
A clear and concise description of what you expected to happen.


Screenshots
If applicable, add screenshots to help explain your problem.


Additional context
Add any other context about the problem here.

Metadata

Assignees

No one assigned

    Labels

    bugSomething isn't workingcommunityLabel for issues created by community members

    Type

    No type

    Projects

    • Status

      Ready to Pull

    Milestone

    No milestone

    Relationships

    None yet

    Development

    No branches or pull requests

    Issue actions