A U.S. District Court judge has found the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) did not exceed their statutory authority when they suspended the collection of data on patient care and satisfaction during COVID-19.
A federal judge on Tuesday rejected an attempt by three Medicare Advantage (MA) plans to require CMS to collect data on patient care and satisfaction during COVID-19.
The MA plans—AvMed, Prominence HealthFirst, and Prominence HealthFirst of Texas, Inc.—brought the suit against HHS in November 2020, alleging that CMS exceeded its authority when it suspended the requirement in the spring of 2020 that health plans submit HEDIS® and CAHPS data because it was unsafe to collect data during COVID-19 and would divert resources from patients. Instead, CMS decided to calculate 2021 Star ratings using the prior year’s CAHPS and HEDIS data along with new data for metrics derived from other sources.
According to the lawsuit, because of the temporary suspension of the quality data collection requirement, AvMed’s overall rating dropped from 4 stars in 2020 to 3.5 stars for 2021, and Prominence HealthFirst’s overall rating declined from 3.5 stars for 2020 to 3 stars for 2021. Prominence HealthFirst of Texas received an overall rating of 2.5 for the third year in a row, which meant it now is labeled a “low performing” plan. The lower ratings meant the three MA plans would receive lower federal payments. Despite the requirement suspension, the plans kept collecting CAHPS and HEDIS data and estimated that had the requirement stood, Prominence’s Texas plan would have improved to an overall 3-star rating, Prominence’s Nevada and Florida plans would have maintained a 3.5-star rating, and AvMed a 4-star rating.
The MA plans claimed the decision was arbitrary and capricious. They moved for summary judgment and a preliminary injunction and asked for a quick ruling because 2022 bids are due by June 7, 2021. Xavier Becerra, secretary of HHS, cross-moved for a summary judgment. A hearing on the matter took place on May 12.
Judge John D. Bates, U.S. District Judge for the District of Columbia, on Tuesday issued a 33-page memorandum opinion that CMS didn’t exceed its statutory authority when it suspended the collection of data and granted HHS’ motion for summary judgment and denied the MA plans’ motions for summary judgment and a preliminary injunction.
Among the reasons Bates outlined for his decision: the challenged rule did not require the collection of any new types of data, and CMS had to act quickly because of the public health emergency and the short time frame in which information is collected, analyzed, and used to calculate Star ratings. In the absence of new CAHPS and HEDIS data, Bates said the agency made the reasonable decision to rely on data collected during the previous measurement period.