Common use of At Risk of Developing Another Chronic Condition Clause in Contracts

At Risk of Developing Another Chronic Condition. Risk of a second chronic condition is defined by a minimum predictive risk score of 1.5. The predictive risk score of 1.5 means a beneficiary’s expected future medical expenditures is expected to be 50% greater than the base reference group, the Washington SSI disability population. The Washington risk score is based on the Chronic Illness & Disability Payment System and Medicaid- Rx risk groupers developed by Xxxx Xxxxxxx and Xxxx Xxxxxx at the University of California, San Diego, with risk weights normalized for the Washington Medicaid population. Diagnoses, prescriptions, age, and gender from the beneficiary’s medical claims and eligibility history for the past 15 months (24 months for children) are analyzed, a risk score is calculated and chronic conditions checked across all categorically needy populations, and a clinical indicator (Y=qualifies; N=does not qualify) is loaded into the Washington Medicaid Management Information System (MMIS).

At Risk of Developing Another Chronic Condition. Risk of a second chronic condition is defined by a minimum predictive risk score of 1.5. The predictive risk score of 1.5 means a beneficiary’s expected future medical expenditures is expected to be 50% greater than the base reference group, the Washington SSI disability population. The Washington risk score is based on the Chronic Illness & Disability Payment System and Medicaid- Medicaid-Rx risk groupers developed by Xxxx Xxxxxxx and Xxxx Xxxxxx at the University of California, San Diego, with risk weights normalized for the Washington Medicaid population. Diagnoses, prescriptions, age, and gender from the beneficiary’s medical claims and eligibility history for the past 15 months (24 months for children) are analyzed, a risk score is calculated and chronic conditions checked across all categorically needy populations, and a clinical indicator (Y=qualifies; N=does not qualify) is loaded into the Washington Medicaid Management Information System (MMIS).