Confirmed Star Ratings Changes in CMS’ Final Rule

With the Centers for Medicare and Medicaid Services (CMS) release of the Final Rule for Contract Year 2021 on May 22, 2020, Medicare Advantage (MA) plans now have some near-term clarity regarding the many Star Ratings proposals made earlier this year.

Following are the key Star Ratings changes finalized through rulemaking:

  • Patient experience measures (including CAHPS and administrative measures) will increase from weights of 2 to weights of 4 beginning with the 2021 performance period.
  • The Rheumatoid Arthritis Measure will be removed beginning in measurement year 2021.
  • The Statin Use in Persons with Diabetes measure will be reduced from a weight of 3 to a weight of 1 beginning with the 2021 measurement year.
  • The Tukey outlier deletion methodology will be adopted in the program, but implementation is delayed to measurement year 2022.

Recognizing the significant and uncertain impacts that the COVID-19 Public Health Emergency is having, and will continue to have, on both plans and providers, CMS also announced that all other proposals previously announced are being postponed until future rulemaking, including:

  • Addition of new Part C HEDIS® clinical measures
  • Implementation of HOS measure updates
  • Enhancement of the Major Disaster policy for contracts impacted by disasters for multiple years

No changes were made to the COVID-19 Star Ratings changes adopted by CMS in the April 6, 2020, Interim Final Rule, though CMS did present the comments received during the Comment Period and their responses to those comments.

Conclusion

Achieving (or sustaining) strong Star Ratings with the increased weight of the CAHPS and administrative measures will require more proactive, nuanced activities than most plans are accustomed to performing—and they should begin no later than the 4th quarter of 2020 for best results.

If you need assistance improving performance on the patient access and experiences measures to ensure your plan’s success, we can help. For additional questions and inquiries about how GHG can support your needs, please contact us.

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