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[SO/URSA-HCC] Standard Initial, Midyear, and Final Run CMS-HCC Model Demographic Inputs

  • Published on Nov 4, 2026
  • 6 minute(s) read
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Object Description

One record per MMR Member-Month Transaction record used to generate a CMS standard Initial, Midyear, or Final Run CMS-HCC RAF score. For Initial Run results, only January - June records with payment month = covered month are used; for Midyear Run results, the most recent MMR records with payment date up through July of that year are used for January - June, and only MMR records with payment month = covered month are used from July - December; for Final Run results, the most recent MMR records with payment date up through November of the subsequent year are used for all calendar months.

Metadata

  • Table Name: ursa.so_ursa_hcc_pat_021
  • Layer: SYNTHETIC_OBJECT
  • Object Type: Single Stack
  • Case ID: Record ID
  • Primary Key: Record ID

Published Fields

  • Data Model Keys

    • Record ID
    • Patient ID -- The internal database identifier (used, e.g., for joins and primary keys) for the patient. This value is typically mastered, i.e., all records for the same patient, regardless of the source data system from which that record originated, should have the same Patient ID value. (Note that while the mastered Patient ID value might resemble a local identifier used in one of the upstream data sources, this does not indicate any special priority of that source system in determining the characteristics of the patient.) (See also [URSA-CORE] Patient)

  • Date Fields

    • Covered Month Start Date -- The start date (e.g., January 1, February 1, etc.) of the month in the patient's life described by the current record.
    • Covered Month End Date
    • CMS MMR Payment Date -- The monthly period, expressed as text in YYYYMM format, in which any new or updated financial calculations in the current MMR record actually contributed to the amount paid by CMS to the Medicare Advantage organization. This field contains the same values as the CMS MMR "Payment Date" field, which the CMS documentation defines as: "Payment month for the report (YYYYMM)" (Note that we use the word "date" in the field name here -- even though the field does not, strictly speaking, contain a date -- for consistency with the official MMR field name.) (See also [URSA-CORE] Covered Month Start Date)
    • Calendar Year Start Date

  • Module Fields

    • CMS-HCC Patient Age -- For a given reference date or month, the patient age, expressed as an integer, evaluated as of February 1 of the calendar year containing the reference date or month; this is the method used to establish a patient's age for calculation of HCC/RAF score results.
    • CMS-HCC Patient Sex Code -- Takes the value of "M" for male patients and "F" for female patients, which are the values expected by the CMS-HCC RAF score model. Because the model requires patient sex as an input, patients are assumed to be female if their sex is not known.
    • Is CMS-HCC Medicaid Patient -- The binary value used by the CMS-HCC model to identify Medicaid patients. Derived, when possible, from the CMS RAF Type Code (obtained either from an MMR record or a membership record). (See also [URSA-HCC] CMS RAF Type Code)
    • CMS-HCC Original Reason for Entitlement Code -- The CMS Original Reason for Entitlement Code (OREC) for the patient used by the CMS-HCC model. Takes the same values as the standard CMS Original Reason for Entitlement Code field. This value is obtained from the MMR if available there, then from the membership record. Because the model requires this code as an input, patients are assumed to be OREC = Aged if their true status is not known. (See also [URSA-CORE] CMS Original Reason for Entitlement Code)
    • CMS-HCC Eligibility Code -- The coded value used by the CMS-HCC model to characterize the patient's community vs. long-term institutional residential status, full dual vs. partial dual vs. non-dual status, and aged vs. disabled Medicare eligibility status. Values are as follows: CFA = Community Full Benefit Dual Aged; CFD = Community Full Benefit Dual Disabled; CNA = Community Non-Dual Aged; CND = Community Non-Dual Disabled; CPA: Community Partial Benefit Dual Aged; CPD = Community Partial Benefit Dual Disabled; INS = Long Term Institutional; NE = New Enrollee; SNPNE = SNP NE. Derived, when possible, from the CMS RAF Type Code (obtained either from an MMR record or a membership record). Because the model requires this code as an input, patients are assumed to be CNA if their true status is not known. (See also [URSA-HCC] CMS RAF Type Code)

  • Patient Fields

    • Patient Age Integer -- Patient age, expressed as an integer, as of a reference date or interval.
    • Is Patient Sex Female -- Indicates the patient's sex is female. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the patient sex documented on that particular type of record in the source data.

  • Insurance Fields

    • CMS RAF Type Code -- The standard 1- or 2-character CMS Part C Risk Adjustment Factor Type Code; e.g., E = New Enrollee, I = Institutional, D = Dialysis (ESRD), CF = Community Full Dual, CP = Community Partial Dual, CN = Community Non-Dual, etc.
    • Is CMS ESRD Status -- Indicates the patient meets the Medicare ESRD eligibility criterion as of a particular date; can be derived from the CMS Medicare Beneficiary Status Code. (See also [URSA-CORE] CMS Medicare Beneficiary Status Code)
    • Is CMS LTI Status -- Indicates the patient meets the CMS criteria to be considered a Long-Term Institutional (LTI) patient. Among other potential uses, this status is used in the calculation of RAF scores.
    • Is CMS New Enrollee Status -- Indicates the patient meets the CMS criteria to be considered a New Enrollee. Among other potential uses, this status is used in the calculation of RAF scores.
    • Is CMS Full Dual Status
    • Is CMS Partial Dual Status
    • CMS Dual Status Code -- The standard 2-character CMS Dual Status Code, which identifies the patient's most recent entitlement status for Medicaid and other qualifying non-Medicare programs; e.g., 01 = QMB only, 02 = QMB + full Medicaid, etc.
    • CMS Original Reason for Entitlement Code -- The standard CMS 1-digit code, commonly abbreviated OREC, identifying the original reason the patient was entitled to Medicare; 0 = Old Age and Survivor's Insurance, 1 = Disability Insurance Benefit, 2 = ESRD, 3 = Both Disability and ESRD, 9 = None of the Above.
    • CMS MMR Risk Adjustment Age Group Code -- That standard 4-digit CMS Risk Adjustment Age Group (RAAG) Code, describing the age category of the patient as used to calculate RAF scores. This field contains the same values as the CMS MMR "Risk Adjustment Age Group (RAAG)" field, which the CMS documentation defines as: "The Risk Adjustment Age Group for the beneficiary (BBEE). In general it is based upon the age as of February 1 of payment year. BB = Beginning Age; EE = Ending Age".

  • Metadata Fields

    • Is Initial Run Record
    • Is Midyear Run Record
    • Is Final Run Record
    • Is Qualifying Initial Run MMR Member-Month Transaction
    • Is Qualifying Midyear Run MMR Member-Month Transaction
    • Is Qualifying Final Run MMR Member-Month Transaction

  • Validation Only Fields

    • Is CMS ESRD Status from MMR RAF Type Code
    • Is CMS LTI Status from MMR RAF Type Code
    • Is CMS New Enrollee Status from MMR RAF Type Code
    • Is CMS Full Dual Status from MMR RAF Type Code
    • Is CMS Partial Dual Status from MMR RAF Type Code
    • Is CMS Full Dual Status According to MMR Original Field
    • Is CMS Partial Dual Status According to MMR Original Field