US · guidance
CMS Pub. 100-16, ch. 7, § 70.2.3
Demographic Factors in the CMS-HCC Model
The CMS-HCC model is a combination of demographic and disease-based factors.
The demographic variables include:
• Age as of February 1st of the payment year.
• Sex of the beneficiary.
• Disabled Status results in the inclusion of additional factors in the risk scores of
community residents who are disabled beneficiaries under 65 years old.
• Original Reason for Entitlement results in the inclusion of a factor in the risk
score for beneficiaries 65 years of age or older who were originally entitled to
Medicare due to disability; the factor differs by the age and sex of the beneficiary.
• Medicaid Eligibility results in the inclusion of an additional factor in the risk
score.
History
(Rev. 114, Issued; 06-07-13, Effective: 06- 07-13, Implementation: 06-07-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
7e44283cd7f2901e5c16e569fd7d6a440fbaeb0c2d18c999a7b994afb99b1653
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