Medicare Advantage star-rating policy shift

Modern Healthcare reported that CMS shocked the industry by scrapping plans to lower star ratings for Medicare Advantage plans facing sanctions for poor compliance. The change will protect up to $350 Milion for Cigna Corp which received sanctions in January. Previously policy stated that any Medicare Advantage plan that faced “intermediate sanctions” would have its quality rating dropped to 2.5 stars or, if their rating was already below 2.5 it would drop to one star.

Richard Lieberman, a Medicare Advantage data consultant at Mile High Healthcare Analytics, said the CMS’ decision could be characterized as “a huge gift or even corporate welfare,” even though it could help insurers that quickly resolve problems. “CMS’ actions definitely send a mixed message to plans,” he said.

Cigna was sanctioned in January when CMS determined that its MA plans had violated numerous rules. Cigna officials would not comment on whether they had advocated for the policy shift.  “As a company committed to delivering quality products and services, we focus on putting customers first. We continue to address the matter in full partnership with CMS.”  Read the full article.