Others question risk-adjustment methodologies, suggesting that MA plans are overpaid due to increased coding intensity and upcoding, with federal regulators and enforcers considering multiple interventions. Let HealthAxis knowledgeable team and cutting edge services keep your business on track and help you navigate change. Document Title. What was good enough last year, may not be good enough the next. . . Washington, D.C. 20201 Private market benefits innovation prompted the expansion of prescription drug benefits from a common feature in private Medicare plans in the 1980s, to becoming a central Medicare benefit implemented in 2006. Stakeholder panelists should prepare a 10-minute PowerPoint presentation to present on the day of the workshop. on the guidance repository, except to establish historical facts. When including category 1.30 complaints, there was an increase in the complaint volumes (numerator) for calculating the performance measure. Part C and D Performance Data This page contains performance data related to the Part C & D programs. Medicare 2020 Part C & D Star Ratings Technical Notes Issued by: Centers for Medicare & Medicaid Services (CMS). Please check back again as this page is updated on a regular basis. 2023 American Medical Association. |, PQS Summary of 2023 Medicare Part C and D Star Ratings Technical Notes, Quality Corner Show Recaps EQUIPP Summer Trade Show Circuit, PQS Launches Next-Generation EQUIPP Platform to Support New Opportunities. Forward-thinking reforms to insurance design are also needed. On Jan. 15, The Centers for Medicare and Medicare Services (CMS) announced changes to Calendar Year (CY) 2022 Medicare and Medicaid Programs. Of the 500+ contracts that CMS rated for 2023, 57 contracts were rated 5 stars. Building a system that works: the future of health care. Published: June 16, 2023. doi:10.1001/jamahealthforum.2023.1571. on the guidance repository, except to establish historical facts. Mr Hargan reports serving as the Deputy Secretary of the Department of Health & Human Services from 2017 to 2021; currently serves as a board director at University Hospitals, Alio, and Capital Pulse; serves as an advisor to Tomorrow Health and HealthTrackRx; and serves as a board member of the Department of Population Science & Policy, Southern Illinois University Medicine. CMS Changes to 2021 & 2022 Star Ratings Data Calculations CMS employs all survey responses in the construction of the HCAHPS Star Ratings. CMS Star Ratings Calendar - Cotiviti Sections 1853(n) and 1853(o) of the Act1 require CMS to make quality bonus payments (QBPs) to Medicare Advantage (MA) organizations that achieve at least 4 stars in a 5-star quality rating system. Policymakers can address these concerns while harnessing the inherent population-level, risk-based incentives in MA. Basing plan payments on a competitive benchmark instead of a percentage of the FFS Medicare administrative benchmark would decouple the Medicare marketplace from administrative pricing. www.codyconsulting.com, Cody Consulting Group, Inc. With the release of the Star Ratings on the MPF tool, the data were also posted at . The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. CMS Releases Proposed Rules for 2023 Medicare Advantage and Part D Plans Special Bulletin January 7, 2021 The agency proposes several policies intended to increase oversight of health plans and solicits information on the impact of prior authorization during a public health emergency Critics rightly note that a small FFS Medicare population in some counties disrupts the FFS-based benchmark underlying the MA bidding system: where MA is very dominant, beneficiaries who remain in the FFS program are more likely to be clinically distinct. Federal government websites often end in .gov or .mil. The agency proposes several policies intended to increase oversight of health plans and solicits information on the impact of prior authorization during a public health emergency. DISCLAIMER: The contents of this database lack the force and effect of law, except as On Jan. 19, the Federal Registrar published the Final Rule detailing those regulatory and measure level updates for the Stars program beginning in Measurement Year (MY) 2022. For your convenience, PQS has summarized the 2023 Medicare Part C & D Star Ratings Technical Notes, which includes general points and highlights, focused updates for medication-related Part D measures, performance trend graphs, and measure threshold charts. Some proposals, such as those relating to health equity and social determinants of health, will take some time to implement. PDF Center for Data Insights and Innovation (CDII) California Health Care In light of the public safety issues in continuing to require the collection, validation, and submission of data for the 2019 measurement year, the first Interim Final rule removed the requirement for Medicare health plans to submit Healthcare Effectiveness Data and Information Set (HEDIS) 2020 data covering the 2019 measurement year for the Medicare program. GR. Customized care for complex conditions in Medicare Advantage. Leaders across administrations, including former US Department of Health and Human Services Secretaries Burwell1 and Leavitt and former Center for Medicare & Medicaid Services (CMS) Administrators Mark McClellan and Don Berwick, have emphasized the need to transition from volume to value to improve outcomes and reduce costs. 2025 Star Ratings Measurement Period | FTI Consulting Currently, state Medicaid coverage of dually-eligible beneficiaries cost-sharing, other secondary payer payments, and unpaid amounts are not counted. Star Ratings Technical Notes . In 2022, MA plan bids averaged 85% of FFS Medicare spending,3 demonstrating the ability of managed care to more efficiently deliver Part A and B benefits through implementation of a provider network and utilization controls. First, for rating year 2023, CMS will no longer universally apply the disaster provision as it did in 2022; this provision allowed contracts to . Before sharing sensitive information, make sure youre on a federal government site. of the lucrative healthcare industry now regularly shuttle between private equity and CMS leadership. AHIP and our member plans will continue to review the latest Star Ratings results and data closely to assess impacts. Stars is also graded against a curve. 200 Independence Avenue, S.W. Since physician compensation has been steadily decreasing for at least three decades, why not simply change the model to one hundred percent altruism? PQS Summarizes the 2022 Medicare Part C & D Star Rating Technical Notes The enrollment used in the calculations is the enrollment . CMS Issues Emergency Regulation Changes for 2022 Star Ratings | Icario Examples of any contrast in a states policies for payers (for example, Medicaid managed care) with respect to prior authorizations for patient transfer that do not pertain to MA organizations, and the effects of such policies on hospitals systems ability to effectively manage resources. 2023 by the American Hospital Association. This information is not meant to preclude clinical judgment. CMS expanded the existing hold harmless provision for the Part C and D improvement measures providing protections against a plans summary or overall rating to decrease due to lower scores as a result of the COVID-19. Without this technical change, CMS will be unable to calculate measure-level 2023 Star Ratings for these measures for any MA contract. Smaller-scale reforms, such as using encounter data to set benchmarks (a transition already executed for MA) and a common core set of quality metrics, remain important. 2022-04-04. . Thats why more than 29 million Americans choose Medicare Advantage: It delivers better services, better access to care, and better value. doi:10.1001/jamahealthforum.2023.1571. The Department may not cite, use, or rely on any guidance that is not posted This measure will have a weight of 1 for the first year (2023 Star Ratings) and a weight of 3 thereafter. Downloads 2024 Categorical Adjustment Index Measure Supplement (PDF) 2023 Display Measures (ZIP) Tukey Outlier Deletion Simulations (ZIP) Cut Point Trends (ZIP) CMS proposes a number of changes in policy to increase oversight of MA plans. Medicare must provide additional cost and access information to enhance decision making around trade offs between Medicare Advantage and Medigap. achieve improved health outcomes. There are also changes to Star Ratings included in the Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs [CMS-4192-P] proposed rule released on January 12, 2022. March 2022. PDF Technical Notes for HCAHPS Star Ratings We encourage you to review these changes and the potential impact to your current processes or changes needed in the future. PHARMACY QUALITY SOLUTIONS PQS Summary of 2022 Medicare Part C and D Star Ratings Technical Notes On October 8th, CMS released the Medicare 2022 Part C & D Star Rating Technical Notes. The story for taxpayers is more complex. All rights reserved. 2. Many require reinvestment to drive continued improvement. Our practitioners have years of experience helping large MCOs enhance quality improvement programs. Leonard CMS Releases Star Ratings for 2023 Medicare Advantage and Part D Plans Visit www.ahip.org to learn how working together, we are Guiding Greater Health. CMS includes several requests for information as part of the proposed rule. Additional questions are also being considered for the survey, including patient-provider communication, getting test results, communication between providers, management of different health services, language spoken at home, experience with video or phone visits and perceived discrimination. To sign up for updates or to access your subscriber preferences, please enter your contact information below. Medica on Reconcilia on Post . On October 8th, CMS released the Medicare 2022 Part C & D Star Rating Technical Notes. The authors cite the action of the AMAs Relative Value Committee and propose its advisory power be expanded, but fail to mention that its perpetual overvaluing of reimbursement for specialty services, and relative underfunding of primary care, has contributed to the fact that seniors now can no longer can find a primary care clinician. Any consequences of delayed patient transfer from hospitals to post-acute care facilities. authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically Commonwealth Fund. Private market actors like the American Medical Associations Relative Value Update Committee could transition into new roles such as developing outcome measures for CMS or assisting health plans with constructing fee schedules. General points and highlights from the report: The 2022 Star Ratings for Medicare Part C & D plans are displayed on the Medicare Plan Finder found at www.medicare.gov. These changes will force health plans to reevaluate their Stars intervention strategies and better communicate to both providers and members. The Department may not cite, use, or rely on any guidance that is not posted This measure has a weight of 1 for 2023 and will increase to a triple weighted measure for 2024. Release Date. CMS Final Rule Stars Program Update - ProspHire The provided history skirts the fact that the private market innovations written by Alex Azar into Part D for the pharmaceutical industry helps drain Medicare by preventing federal negotiation over prices, and avoids mention of PBMs. The overall impact of both the relaxation and reinstatement of prior authorization requirements for patient transfer by MA organizations on the provision of appropriate patient care in hospital systems. American Enterprise Institute. Uniting the need for transitioning to value-based care with fiscal sustainability and a comprehensive, integrated health benefits package, the future of Medicare favors MA. Take a look at this calendar as a reminder of proposed and confirmed upcoming changes to the CMS Star Ratings system for 2024 and beyond. The audience is Part C and D plan sponsors and stakeholders. Revolutionizing the Way Health Plans Operate, Phone: 855-990-2639 PQS Summarizes the 2023 Medicare Part C & D Star Ratings Technical Notes To request permission to reproduce AHA content, please click here. 2023 Miller BJ et al. Calendar Year (CY) 2023 Measure Technical Specifications Last Revised: June 13, 2023. Finally, policymakers can support the transition from volume to value by addressing default enrollment into FFS Medicare. 04/03/2023 2. Changes to the Star Rating Program . TG, Landon A managed care program based on risk-adjusted capitation, Medicare Advantage (MA) today is close to commanding a majority share of Medicare program enrollees nationally, and in some markets dominates FFS Medicare. PDF PQS Summary of 2022 Medicare Part C and D - Pharmacy Quality Download the Guidance Document Final Overall, 51% of the contracts rated for next year received 4 stars or better. CMS issued an emergency regulation on August 25 th changing its policy on extreme and uncontrollable circumstances for the 2022 Star Ratings. Here . Page 5 of 10. Pharmacy Quality Solutions (PQS) is a healthcare technology company focused on enabling data-driven quality improvement opportunities for payers and providers so patients can CMS proposes a number of policy changes related to SNPs. The public reporting of the HCAHPS Star Ratings in January 2023 will be based on patients discharged between April 1, 2021 and March 31, 2022. All Rights Reserved / Terms of Use / Privacy Policy, Improving or Maintaining Physical Health, These measures will be retired to the Display Page for at least two years (beginning in MY2022); These measures will be retired at least for SY2024 and SY2025, with the earliest return to Star Ratings in SY2026 at a weight of 1, and Star Ratings in SY2027 and beyond will be a weight of 3, Medication Reconciliation Post Discharge (MRP), This measure will be retired as a standalone measure in MY2022, SY2024, Follow-up after Emergency Department Visit for Patients with Multiple Chronic Conditions (FMC), This measure will be added in MY2022, SY2024, with a permanent weight of 1 as a process measure, This measure will be added beginning in MY2021, SY2023 with a 1x-weight, increasing to 3x-weight in MY2022, SY2024, This measure will be added in MY2022, SY2024 with a 1x-weight, increasing to a 3xc-weight in MY2023, SY2025, MY = Measurement Year, the calendar year the measures are tracked and calculated for Star Ratings; SY = Star Year, the year that the official Star Ratings are received, Source: CMS-provided information and documentation. Accessed January 5, 2023. The responses to the survey items used in each HCAHPS measure (shown below) are scored linearly, adjusted, rescaled, averaged across quarters, and rounded to produce a 0-100 linear-scaled score ("Linear Score"). 2 2023 CMS Star Ratings comprise 40 Star measures across nine domains, sourced from multiple datasets. December 12, 2016. CMS Star Ratings Calendar. Centers for Medicare & Medicaid Services (CMS) End-Stage Renal Disease Quality Incentive Program (ESRD QIP) 1 . 52 plans (85% of eligible clients) achieved a 4-star rating or higher. For the 2022 Star Ratings, CMS adopted a number of changes to address the impact of the 2019 Novel Coronavirus (COVID-19) in the Medicare and Medicaid Programs and to encourage that members and patients faced minimal hurdles to receiving necessary care and treatment. Washington, D.C. - October 6, 2022 - Matt Eyles, President and CEO of AHIP, issued this statement as the Centers for Medicare & Medicaid Services (CMS) announced the 2023 Medicare Advantage Star Ratings: Risk adjustment and quality ratings would be applied equally to all plans, including the FFS Medicare plan. CMS Releases Proposed Rules for 2023 Medicare Advantage and Part D Some changes may impact Star Ratings for CY 2023. On January 15, 2021, CMS relea sed the Contract Year 2022 Medicare Advantage and Part D Final Rule. Yet MA program expenditures consisting of taxpayer-funded plan payments averaged 104% of FFS spending due to MA program design driven by star ratings, quality bonuses, and coding intensity.3. CMS employs all survey responses in the construction of the HCAHPS Star Ratings. Grabert JM, Afendulis Technical Notes Medicare Part C . For example, the measurement period for 2023 ratings primarily occurs in 2021. 200 Independence Avenue, S.W. CMS found a decrease in stars for almost one-quarter of plans. CMS says it will calculate the Part C and D improvement measure scores for the 2022 Star Ratings as codified, but recognizes that the COVID-19 outbreak may result in a decline in industry performance, therefore expanding the hold harmless rule to include all contracts at the overall and summary rating levels.. About CODY:CODY works with over 70 government-funded, commercial, and ACA health plans across 50 states and Puerto Rico. The Centers for Medicare & Medicaid Services (CMS) announced it will put patients over paperwork to provide temporary relief from many paperwork, reporting and audit requirements so providers, health care facilities, Medicare Advantage, and Part D plans, and States can focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19.. The average PDP Star Rating increased from 3.58 Stars in 2021 to 3.70 in 2022. Comparing spending across Medicare programs. 0% of eligible client plans achieved a lower rating than in 2021. Comments on the rule are due March 7. CMS is seeking comments on the CAHPs survey process and questions. A robust trade-off framework of FFS Medicare and MA for both beneficiaries (or their proxies) and policymakers4 is a requirement to promote consumer protection in the setting of choice paralysis10 and healthy programmatic oversight. For newer contracts where the 2021 Star Ratings would be the first year that they would receive a Star Rating, CMS will treat them as new for an additional year since CMS would not have enough data to assign a rating. D, Werner For your convenience, PQS has summarized the 2023 Medicare Part C & D Star Ratings Technical Notes, which includes general points and highlights, focused updates for medication-related Part D measures, performance trend graphs, and measure threshold charts. Star Ratings: What's Ahead | FTI Consulting The site is secure. Click here for more AHIP Medicare Advantage resources. Medicare 2020 Part C & D Star Ratings Technical Notes Guidance for the document that describes the methodology for creating the Part C & D Star Ratings displayed on the Medicare Plan Finder (MPF) at http://www.medicare.gov/ and posted on the CMS website at http://go.cms.gov/partcanddstarratings. Payment levels should be addressed through the gradual transition to a competitive bidding model inclusive of FFS Medicare, which would remain an option for beneficiaries. Email: Sales@codyconsulting.com, 2023 Cody Consulting Group, Inc.. All Rights Reserved. BJ. incorporated into a contract. Noncommercial use of original content on www.aha.org is granted to AHA Institutional Members, their employees and State, Regional and Metro Hospital Associations unless otherwise indicated. Today, the program faces questions of fiscal sustainability, with hospital insurance (Part A) trust fund insolvency projected for 2028. We look forward to engaging with CMS to address methodological and other issues to ensure that there are accurate, reliable indicators of plan performance. S, Navathe PDF Medicare 2022 Part C & D Star Ratings Technical Notes Medicare Program; Contract Year 2024 Policy and Technical Changes to Approximately 90% of MA-PD enrollees are currently in contracts that will have 4 or more stars in 2022 while ONLY 42% of PDP enrollees are in a Medicare contract with a rating of 4 or more stars for the 2022 plan year. These changes will force health plans to reevaluate their Stars intervention strategies and better communicate to both providers and members. These include proposals to: CMS proposes to modify the methodology for calculating three quality measures for 2023 as a result of the COVID-19 public health emergency: Monitoring Physical Activity, Reducing the Risk of Falling, and Improving Bladder Control. Measures apply only to Special Needs Plans 3. All Rights Reserved, Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, 2023;4(6):e231571. There are also changes to Star Ratings included in the Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs [CMS-4192-P] proposed rule released on January 12, 2022. With a mission as bold as ours, we are continuously seeking the best and brightest to join us. . R, Connolly The main difference between complaints in categories 1.30 and 2.30 is that CMS may need to act for complaints in category 1.30, whereas cases where a beneficiary wants a prospective action are in 2.30. As of October 15, 2021, Medicare beneficiaries can view these 2022 Star Ratings when selecting their MA-PD or PDP for the 2022 benefit year as part of the Open Enrollment period which will continue through December 7, 2021. Also of importance to hospitals and health systems are requests for information (RFI) related to: MA prior authorization policies and their effect on patient access to care and health system capacity during a public health emergency; and enrollee access to behavioral health services. We are therefore finalizing 422.166(i)(12) without modification. The agency proposes to make effective the special requirements until either 30 days after the end of the disaster or emergency or 30 days after the disruption of access to health care ends. Daniela Simpson 480.581.7643 Daniela.Simpson@wakely.com On December 14. , McWilliams By continuing to use our site, or clicking "Continue," you are agreeing to our. Complex Medicare Advantage choices may overwhelm seniorsespecially those with impaired decision making. But the health of a Stars program is critical to a health plans growth and sustainability. When CMS initially issued the interim final rule (IFR) in March, it made certain regulatory changes due to the public health emergency (PHE) that ensued from COVID-19, including changes to its disaster policy for extreme and uncontrollable circumstances. CMS assessed the change using 2019 CTM data from the 2021 Star Ratings. In contrast, there is a huge burden of costs to practices and hospitals to interact with a slew of proprietary forms, formularies and utilization restrictions erected by Medicare Advantage programs. The .gov means its official. , Chakravarthy , 2023 American Medical Association. We have led the industry for decadesand we have the tools and resources to serve you. ProspHire is adept at helping our clients quickly assess the impacts of CMS measure updates and developing strategies for continuous improvement. GR. The fiscal sustainability of Medicare has been eroded by decades of exploding American prices for hospital services, drugs, medical devices, radiology imaging, and more. RM. DISCLAIMER: The contents of this database lack the force and effect of law, except as Guidance for the document that describes the methodology for creating the Part C & D Star Ratings displayed on the Medicare Plan Finder (MPF) at http://www.medicare.gov/ and posted on the CMS website at http://go.cms.gov/partcanddstarratings. The Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Advantage (Medicare Part C) and Medicare Part D Star Ratings each year to measure the quality of health and drug services received by consumers enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans). The responses to the survey items used in each HCAHPS measure (shown below) are scored linearly, adjusted, rescaled, averaged across quarters, and rounded to produce a 0-100 linear-scaled score ("Linear Score"). SC, Wilensky Each Project Lead (or a delegate) should plan to present an in-person project talk during plenary. Complaints in category 2.30 (Plan Lead Marketing Misrepresentation: Allegation of inappropriate marketing by plan, plan representative, or agent/broker) are currently included in the Complaints against Health/Drug Plan measure specifications. Read the 7 things you need to know about Medicare Advantage. While CMS estimates this will result in certain plans submitting high-bid amounts, the agency also estimates it will save state Medicaid agencies $2 billion over 10 years and increase payments to providers by $8 billion. HEDIS Technical Resources HEDIS Technical Specifications include a complete list of new and updated HEDIS measures with instructions on data collection and guidelines for calculations and sampling. 3 "CY 2023 Medicare Advantage and Part D final rule (CMS-4192-F)," CMS, April 29, 2022. CMS proposes using a web survey for a sample number of enrollees. Copyright 2023 Pharmacy Quality Solutions, Inc. All Rights Reserved. Perhaps thats because primary care just didnt make anyone rich. To view the 2023 Advance Notice, please visit: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Announcements-and-Documents and select 2023. Toll Free Call Center: 1-877-696-6775. The methodology outlined by CMS clarified that the enrollment figures used in the enrollment weighted QBP rating calculations are the Nov. enrollment in the year the Star Ratings are released. Previous Version Description of Change Revision Date OMB Approved Data Sources . Offeringextensive, flexible front andback-office administrationwith a, HealthcareDive - A recap of the National Business Group on Health's 2017 Business Health Agenda, The majority of errors were attributed to the human-computer interface, workflow and communication, and clinical, Compliance & Ethics Hotline-Powered by Convercent 855-969-5859. Terms of Use| . The complete version of the CMS Technical Notes can be found here. CMS set a June 30, 2022, deadline for contracts to make their requests for Independent Review Entity (IRE) review of the Part C appeals data and for CMS review of CTM measure data. Two notable ones for hospitals and health systems include: Comments are due March 7, 2022. These complaints related to beneficiary confusion around misleading marketing materials and/or inadequate training of marketing personnel. Other measures have proposed changes and CMS is seeking comments. Federal government websites often end in .gov or .mil. Stand-alone Part D (PDP) contracts are rated on up to 12 measures. Specifically, these measures are Monitoring Physical Activity, Reducing the Risk of Falling, and Improving Bladder Control. SM. Downloads. Links to upload your talk under My Account will be made available in September.
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