In the wake of recent court rulings about Star ratings, the Centers for Medicare & Medicaid Services (CMS) sent a memo to Medicare Advantage (MA) compliance officers that the agency has recalculated the 2024 Star ratings for 2025 Quality Bonus Payments.
CMS sent the memo late Thursday announcing that it would reassess Star ratings to address the application of Tukey outlier deletion and guardrails after the recent rulings in favor of SCAN Health and Elevance Health, which determined the agency must recalculate their 2024 Star ratings.
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However, CMS officials said they have not decided yet whether to appeal those judgements and their decision to recalculate all 2024 ratings doesn’t mean they won’t appeal the rulings in the future. In addition, the agency said it is not announcing any policy or position statement about the calculation of the 2025 Star ratings that will be issued in October.
The new calculations mean that MA plans with higher ratings could receive lucrative bonus payments they can use to reinvest and offer members additional benefits in 2025.
CMS recalculated the 2024 Star Ratings using the published 2023 Star Ratings cut points to determine the guardrails for the 2024 Star Ratings (Tukey outliers were not removed from the 2023 Star Ratings), wrote Kathryn A. Coleman, director, Medicare Drug & Health Plan Contract Administration Group, Vanessa S. Duran, director, Medicare Drug Benefit and C & D Data Group, and Jennifer Lazio, director, Parts C & D Actuarial Group, Office of the Actuary, in the memo.
Plans will now receive the recalculated 2024 overall ratings if the reassessed ratings resulted in a higher quality bonus payment rating than was previously assigned. “If this recalculation would result in a contract’s QBP Rating decreasing compared to the ratings previously assigned, CMS is not implementing the change for those contracts and those contracts will be held harmless in this recalculation,” they said.
MA plans can view their updated ratings in the Health Plan Management System.
Plans have until June 28th to submit their 2025 bids.
Editor's note: The original article indicated that plans had to notify CMS by June 28th if they wanted to resubmit their bids. CMS must be notified by June 24th and plans have until June 28 to resubmit their bids.