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expenditure amounts), and frailty scores have an average value of zero, the application of a frailty adjustment to all MA plans would result in many plans receiving a negative frailty adjustment. As noted in the CY 2026 Advance Notice, CMS is continuing to evaluate the underlying patterns driving the changes in the 2024 CMS-HCC model frailty factors and welcomes feedback on improving the HOS/HOS-M survey administration process. Frailty for PACE Organizations Comment: A commenter expressed support for the proposal to blend the frailty factors associated with the 2017 CMS-HCC model and 2024 CMS-HCC model to calculate frailty scores for PACE organizations for CY 2026 payment. Response: CMS appreciates the support. CMS is finalizing the proposed blend of frailty factors associated with the 2017 CMS-HCC model at 90 percent and 2024 CMS-HCC model at 10 percent to calculate frailty scores for CY 2026 for PACE organizations. Comment: A few commenters expressed concern about the transition of PACE from the 2017 CMS-HCC model to the 2024 CMS-HCC model and suggested CMS maintain frailty factors associated with the 2017 CMS-HCC model for 5 or more ADLs to ensure PACE receives adequate funding to support its most complex and frail participants. Response: The transition of PACE organizations to the CMS-HCC risk adjustment model used for MA payment will take place over multiple years. CMS has laid out a tentative schedule that would fully transition PACE organizations to the model used for MA organizations and its associated frailty factors over four years, as described in the CY 2026 Advance Notice. For CY 2026, CMS will calculate risk scores using a blend of 90 percent of the risk score calculated using the 2017 CMS-HCC model and 10 percent of the risk scores calculated using the 2024 CMS-HCC model. Consequently, CMS will also use a corresponding blend of the frailty factors associated with the 2017 CMS-HCC model and 2024 CMS-HCC model to calculate frailty scores for PACE organizations for CY 2026 payment. Comment: A few commenters raised concerns that the frailty factors associated with the 2024 CMS-HCC model do not adequately reflect the frequency and severity of dementia. Commenters expressed concerns with using the HOS-M survey to estimate frailty because of low response rates (especially amongst those with dementia), and that reliance on the HOS-M for frailty adjustment does not consider the challenges faced by people with dementia in completing the survey. Commenters suggested that CMS allow PACE organizations to serve as proxies that can complete the survey on behalf of those with dementia, providing a more accurate reflection of the PACE participant’s ADL status.