CMS axes a Medicare Advantage star rating measure: 5 things to know

CMS is removing a star rating unit for Medicare Advantage plans, according to its 2019 Rate Announcement and Call Letter.

Here are five things to know about the decision.

1. Medicare ranks Medicare Advantage plans on a quality scale of one to five stars, and pays bonuses to plans with high ratings. Beginning in 2019, CMS will remove its Beneficiary Access and Performance Problems measure from its star rating calculations.

2. The BAPP measure considers CMS' sanctions, civil money penalties and compliance data like notices of noncompliance, warning letters and corrective action plans.

3. When CMS solicited feedback on BAPP in 2018, commenters recommended revising the measure due to "differences in methodologies and goals, the subjective nature of audits, and the absence of audit information for each plan each year." Advocates of the measure strongly opposed omitting BAPP.

4. "Based on the feedback, the strong support for a change to the measure specification, and concerns for providing additional notice and time to prepare for the significant changes, CMS decided to retain the current BAPP measure in the 2018 Star Ratings." However, BAPP will be retired in 2019 and CMS will "introduce a new measure for the display page."

5. CMS received mixed reactions to its decision to axe the BAPP measure from its 2019 star ratings. Those opposed to the decision were beneficiary advocacy groups, who said the removal will "mask plan behaviors that could pose a serious threat to the health and safety of beneficiaries." Insurers, conversely, largely supported the decision.

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