ARTICLE
The annual Medicare Advantage (MA) Star Ratings Plan Preview period is officially underway!
Reminiscent of the days before rule-making (and probably triggering for some of us long-timers in MA), the Centers for Medicare and Medicaid Services (CMS) announced a last-minute technical policy change along with their release of measure rates for health plan validation.
Let’s start with the “new news” from CMS announced simultaneously with the release of Plan Preview 1 data:
- The 3x-weighted HOS measures of Improving and Maintaining Physical Health and Improving or Maintaining Mental Health will be retired earlier than planned. These measures were already slated to be temporarily retired to Display for the 2024 and 2025 Star Ratings. However, with questions looming regarding measure reliability due to the COVID-19 pandemic, CMS has elected to retire them to Display immediately, effective with the 2022 and 2023 Star Ratings.
- CAHPS cut points have now been computed, and in an unpleasant surprise to many plans, most cut points increased despite the many COVID-19 challenges experienced during 2020 and 2021:
The enormous impact of this last-minute announcement on 2022 Star Ratings has served as a noisy distraction this week. But it’s important to remember that there is important work to be done to validate measure rate accuracy between now and 5pm on August 16.
For my friends and colleagues busy validating measure rates this week, here are some things to make sure you confirm:
- Validate the accuracy of every measure rate. Tie your HEDIS® rates to your official HEDIS data; PDE rates to your Acumen data; administrative rates to the official data for each measure; and CAHPS/HOS rates to the survey results released last week. Make sure all decimals are rounded properly.
- Validate the disposition of every FL/TTY call failure. The universe for these measures is tiny and errors can (and do) happen in classifying calls as failures. Read the notes for each failure, listen to and retime each call, and confirm the validity of each failure.
- Validate the proper capture of SNF and inpatient stays in Medication Adherence measure calculations. There are always a few plans (typically with small service areas) with enough facilities failing to transmit data that it impacts measure rates. Don’t worry about sophisticated, beautiful analytical processes at this point—just run Part C queries and recompute measure rates to confirm that qualifying stays were properly captured for non-adherent members.
If you see any anomalies in your data or rates, make sure to submit your feedback to CMS before the deadline. We’ve already heard from numerous plans with data accuracy errors and surprising COVID-related impacts that warrant attention from CMS. And don’t forget: CMS requires all rate disputes to be submitted during Plan Preview 1 to receive any consideration from CMS once ratings are released during Plan Preview 2. If you need assistance or have questions, our team of Medicare Advantage experts stands ready to give you answers. Email any questions to me at Melissa.Smith@Healthmine.com.