The Trump administration aimed to curtail use of a policy intended to help ensure natural disasters don't wreck the calculation of star ratings for Medicare Advantage and Part D plans.
The reason is the policy, only intended to help a few plans, now applies to almost all plans due to the COVID-19 pandemic.
The change was tucked into a massive emergency regulation released Tuesday by the Centers for Medicare & Medicaid Services on COVID-19. The regulation installed new reporting requirements for hospitals and labs surrounding COVID-19, amid other changes.
CMS posts online star ratings on each MA and Part D plan based on a series of quality and performance measures. The rating is also used to determine the amount of quality bonus payments for plans.
CMS calculates star ratings for Medicare Part D and MA plans based on their performance two years ago. The 2022 star ratings will be based on 2020 plan performance.
But the COVID-19 pandemic has affected all plans this year. Healthcare use has dropped dramatically as hospitals had to scale back elective procedures and patients are hesitant to go to the hospital and physician's office.
The new emergency regulation changes a disaster policy that CMS implemented a few years ago to help plans that have a lot of beneficiaries in a natural disaster area.
The policy said that if 60% or more of a MA or Part D plan’s beneficiaries are in a federally designated disaster area then that plan’s star rating gets an adjustment to compensate. Over the past several years when the policy has been enacted, it has applied to a limited number of plans.
“The disaster policy was not designed to address global pandemics,” the rule said.
But the pandemic now counts as a disaster and most plans will be eligible for the disaster policy adjustments, CMS said in the rule. The agency said that if all U.S. plans are affected by the policy, then it will throw off the entire methodology for calculating and assigning star ratings.
So in the new rule CMS is removing the 60% policy for COVID-19 areas to “avoid having to exclude the vast majority of contracts from the methodology used to assign star ratings.”
CMS said it is making the change now via emergency regulation so that plans have certainty about how their ratings will be calculated.
This will help them “focus on providing the best care possible to beneficiaries during the remainder of the 2020 measurement period,” the rule said.
Back in March at the onset of the pandemic, CMS released a proposed rule that eliminated several requirements and changes to the star ratings calculations.
For instance, it eliminated the requirement to collect and submit Health Effectiveness Data and Information Set and a separate health outcomes survey.