The Base Beneficiary Premium for Part D is limited to the lesser of a 6% annual increase, or the amount that would otherwise apply under the prior methodology had the IRA not been enacted. In addition, restricting access to a network of retailers disadvantages MA members without steady transportation, limited accessibility or mobility, or those that may be low income and reliant upon these rewards to help purchase necessities. Telehealth has always been critical, yet there is an assumption that everyone has access. Therefore, investments in these measures will remain crucial for your MAOs Stars strategy. A contract would need to meet the reliability and minimum denominator CMS continues to weigh these adherence measures significantly.8 Therefore, for health plans, these adherence measures should continue to be at the top of their Stars strategy. up to 28 measures; and stand-alone PDP contracts are rated on up to 12 measures. The views expressed herein are those of the author(s) and not necessarily the views of FTI Consulting, Inc., its management, its subsidiaries, its affiliates, or its other professionals. The cap is: for 2024 Star Ratings. These hospitals were less likely to report at least 3 mortality measures or HCAHPS measures. Transitions of Care now includes four indicators, and the Star measure will be an average of all four: Medication Reconciliation Post-Discharge, Notification of Inpatient Admission, Patient Engagement After Inpatient Discharge and Receipt of Discharge Information. https://www.fticonsulting.com/insights/articles/star-ratings-whats-ahead. Read here for a deeper dive into the proposed changes, their impact, and next steps. CMS publishes Medicare Advantage Star Ratings for each health plan to help consumers compare Medicare Advantage quality among multiple health plans. CMS calculated the rating with and without the improvement measure, applying the highest score. Like the COL measure, the Medication Therapy Management (MTM) program completion rate for Comprehensive Medication Review (CMR), also increased at every star cut point- a large 21 point increase for the Two-Star cut point and an 11 point increase for the Three-Star cut point.11 Health plans that use MTM vendors for member outreach should consider a new approach to gap closures, one that focuses on hard to reach members having an in-house health plan pharmacist conduct outreach for MTM gap closure. The chart below indicates the expected impact of the proposed policy changes on MA plan payments relative to last year. 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. To submit comments or questions electronically, go to www.regulations.gov, enter the docket number CMS- 2023-0010 in the search field, and follow the instructions for submitting a comment., The 2024 Advance Notice may be viewed by going to: https://www.cms.gov/files/document/2024-advance-notice.pdf and selecting 2024 Advance Notice., CMS News and Media Group contracts. The CMS Star Ratings Medicare Advantage Plans are graded on a one to five Star Rating system by CMS. With many Medicare Advantage plans seeing a decline in the 2023 Star Ratings, here are three strategies from Cotiviti to help plans regain their footing. IQR CMS Measures for FY 2024 Author: HSAG Subject: CMS Hospital IQR Program Measures for the FY 2024 Payment Update Keywords: CMS Hospital IQR Program Measures for the FY 2024 Payment Update Created Date: 1/14/2022 11:20:47 AM Additionally, CMS is calling for this proposed rule to expand towards individualized care plans (ICPs) for Special Needs Plans (SNPs), showing their focus on breaking down language barriers in the healthcare experience. CMS finalized the addition of the HEDIS The 2023 and 2024 Star Ratings changes will more accurately reflect CMSs mission to improve experience and outcomes, especially for those members who are high-touch within the healthcare system. Star Ratings are released annually and reflect the experiences of people enrolled in Medicare Advantage and Part D prescription drug plans. Medicare First, CMS is removing the guardrails to enable true measurement of performance without penalizing plans due to COVID-19. 2024 CMS Beginning in CY 2024, the growth in the Base Beneficiary Premium will be capped at 6 percent. WebCMS Star Ratings Calendar. Specifically, across our CMS quality rating and value-based care programs, where applicable, we are considering including what CMS is calling a Universal Foundation of quality measures, which is a core set of measures that are aligned across programs. STAR Dear Deputy Administrator Seshamani: The National Committee for Quality Assurance (NCQA) thanks you for the opportunity to comment on the 2023 Medicare Advantage (MA) Advance Notice. CMS The average2023 Medicare Advantage Star Ratingsdropped by almost a quarter of a point after seemingly less significant program modifications. Included in the 2024 growth rate estimate is a proposed technical correction to the per capita cost calculations related to indirect and direct medical education costs associated with services furnished to MA enrollees; this correction results in a one-time adjustment to the growth rates. During CY 2024, Part D plans must not apply the deductible to an adult vaccine recommended by the Advisory Committee on Immunization Practices and must charge no cost-sharing at any point in the benefit for such vaccines. This proposal will allow CMS to respond more quickly to measure removals by external measure stewards to ensure that measures included in Star Ratings are clinically meaningful, reliable, and up to date. Here are some trends and changes that health plans should be aware of from this past year as well as trends to watch for in the coming years. Break down the stigma of mental health in minority communities with awareness and engagement. This guardrail stability will result in an increase in the return on investment for non-CAHPS measure enhancements. The Star Ratings system supports CMSs efforts to empower people to make health care decisions that are best for them. Today, the Centers for Medicare & Medicaid Services (CMS) released Part II of the Calendar Year (CY) 2022 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the Advance Notice). 8: 4 Elements of a Successful Medication Adherence Strategy, RxAnte (Last visited January 21, 2023), https://www.rxante.com/health-plans/4-elements-of-a-successful-medication-adherence-strategy/. CMS Star After analyzing the data, CMS found that 4 and 4.5-star plans had room for improvement. The Advance Notice contains detailed descriptions of these updates. Medicare Advantage plans also earn Quality Bonus Payments (QBP) if they score well on quality measures. Sign up to get the latest information about your choice of CMS topics in your inbox. 13: 3 Impacts of COVID-19 on Your Star Rating Strategy, Outcomes MTM, A Cardinal Health Company (Last visited January 25, 2023), https://outcomesmtm.com/wp-content/uploads/2021/06/Star_Rating_Cut_points_whitepaper_final.pdf. 2022 was a record-breaking year with the highest number of 4- and 5-Star Ratings. These measures have recently increased, going from a 1.5 weight, to a 2.0 weight in 2021 and up to a 4.0 weight in 2023. Measures Amid changes that took place over the past two years to adjust to the pandemic and CMS anticipates that this deletion methodology would create a savings of over $800 million for 2024 and increasing to $1.45 billion in savings by 2030. It would include those who receive low-income subsidies, those dually eligible, and those with a disability as the social risk factor group to be measured. CMS chose to temporarily suspend the 60% rule. It suggests once a plan learns of an enrollees preferred language, whether through an individual request, health risk assessment (HRA), or an additional member touchpoint, the plan must provide required materials in that identified language as long as the enrollee: 1) remains with the plan, or 2) requests another language. Previously, CMS only included the Medication Reconciliation Post-Discharge as the Star measure.17 With the shift to now include all four indicators, the overall Star Ratings may see a negative impact, as two of these care gaps (Notification of Inpatient Admission and Receipt of Discharge Information) can only be closed during a medical record review and no claims data can be used to meet measure compliance. Learn how health plans can better understand and prioritize the actions needed to offer better care to their Medicare Advantage population and to improve bonus payments. To submit comments or questions electronically, go to, , enter the docket number CMS- 2023-0010, in the search field, and follow the instructions for submitting a comment.. Medicare Baltimore, MD 21244. Federal Register :: Medicare Program; Contract Year 1Rebasing/re-pricing impact is dependent on finalization of the average geographic adjustment index and will be available with the publication of the CY 2024 Rate Announcement. The Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Advantage (Medicare Part C) and Medicare Part D Star Ratings each year to If this protection is removed, the improvement measures can once again drag down the ratings of plans with lower Star Ratings. The table below lists all possible measures that could be included. At a weighting of 2.0, it drops to about 40%. Individual plans experience will vary. Star The three measures are: UPDATES TO THE CMS STAR RATING SYSTEM AND The proposed rule suggests plans must provide ongoing materials in all languages spoken by 5% or more of their served population by delivering fully translated materials or offering an equivalent experience in a different manner. Today, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the Advance Notice). The 2025 Star Ratings are based on the 2023 measurement period (MY 2023), which captures health services primarily provided between 1/1/2023 and 12/31/2023.5 In this article, we discuss the 2025 Star Ratings landscape including Star cut points, guardrails, new Star measures and increased weights reflecting member experience measures like the Consumer Assessment of Healthcare Providers and Systems program (CAHPS). (November 3, 2022). WebAll summaries of the measures contained herein are reproduced with permission from HEDIS MY2020 and MY2021, Volume 2: Technical Specifications for Health Plans by the National Committee for Quality Assurance (NCQA). Changes to existing Star Ratings measures for the 2023 measurement year Table 5 is a high-level summary of the steps CMS is proposing to take to calculate the HEI. CMS proposes that MA organizations develop and maintain procedures to identify and offer digital health education to enrollees with low digital health literacy to assist with accessing any medically necessary covered telehealth benefits. These measures, listed below, will require new member-level data analysis, internal process changes, and intervention So rules proposed now wont take effect until 2026. Quality Measures CMS is looking to learn how MA plans interpret and implement the current R&I programs guidance and whether stakeholders believe further framework and definition around cash equivalents is needed. (October 6, 2022). The 2022 Star Ratings are inand many health plans should be happy with the results. The proportion of Medicare beneficiaries who receive benefits through MA (as opposed to Medicare FFS) is far greater in Puerto Rico than in any other state or territory. CMS is also proposing the addition of five new HEDIS and Part D measures in measurement year 2024 (Star Year 2026). CMS ranks Medicare Advantage on a quality scale of one to five stars, with five representing excellent performance and one reflecting poor performance. 2024 CMS WebCMS is anticipating big changes in the Star level cut-points. CMS Proposes Significant Changes 2023 FTI Consulting, Inc., including its subsidiaries and affiliates, is a consulting firm and is not a certified public accounting firm or a law firm. Removing those outliers might move the cut lines higher. This final rule will revise the Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), Medicare cost plan, and Programs of All-Inclusive Care for the Elderly Medicare Stars Measures SY2024 (MY2022) Transitions of Care (TRC) This year, Centers for Medicare and Medicaid Services (CMS) will begin collecting Health Effectiveness Data and
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