CMS released the “Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies” on February 2, 2022, with feedback accepted until March 4, 2022. Some changes may impact Star Ratings for CY 2023. To submit comments or questions electronically, go to www.regulations.gov, enter the docket number “CMS-2022-0021” in the “Search” field.
Change to Processes.
CMS is seeking comments on the CAHPs survey process and questions. CMS proposes using a web survey for a sample number of enrollees. Additional questions are also being considered for the survey, including patient-provider communication, getting test results, communication between providers, management of different health services, language spoken at home, experience with video or phone visits and perceived discrimination.
CMS finalized an increase in the weight of patient experience/complaints and access measures from 2 to 4 for the 2023 Star Ratings. They also finalized the Part D Statin Use in Persons with Diabetes measure weighting category (from an intermediate outcome measure with a weight of 3 to a process measure with a weight of 1) for the 2021 measurement year and the 2023 Star Ratings. Controlling Blood Pressure (Part C) measure will be moved from the display page and to the 2023 Star Ratings as a new measure. This measure will have a weight of 1 for the first year (2023 Star Ratings) and a weight of 3 thereafter.
CMS set a June 30, 2022, deadline for contracts to make their requests for Independent Review Entity (IRE) review of the Part C appeals data and for CMS review of CTM measure data. Sponsoring organizations can view and monitor their Part C appeals timeliness and effectuation compliance data on the website medicareappeal.com/AppealSearch.
CMS has proposed to add Beneficiary Access and Performance Problems (BAPP) back to Star Ratings. This measure was removed from the Star Ratings for 2019 and is currently on the display page. The display measure only reflects the Compliance Activity Module (CAM) measures, which plans can monitor in the CAM within Health Plan Management Services (HPMS). The CAM includes notices of non-compliance, warning letters (with or without business plan), ad-hoc corrective actions plans (CAPs) and the severity of CAPs. Previously, the BAPP was broader and included CMS sanctions and civil money penalties (CMP), as well as CAM data. CMS is also seeking feedback on the display measures and which enforcement actions should be included in the BAPP, include sanctions and CMPs.
CMS is also seeking comment on including Complaints Tracking Module (CTM) category 1.30 (CMS Lead Marketing Misrepresentation: Allegation of inappropriate marketing by plan, plan representative, or agent/broker) in the Complaints about the Health/Drug Plan (Part C and D) measure. These complaints related to beneficiary confusion around misleading marketing materials and/or inadequate training of marketing personnel. Complaints in category 2.30 (Plan Lead Marketing Misrepresentation: Allegation of inappropriate marketing by plan, plan representative, or agent/broker) are currently included in the Complaints against Health/Drug Plan measure specifications.
The main difference between complaints in categories 1.30 and 2.30 is that CMS may need to act for complaints in category 1.30, whereas cases where a beneficiary wants a prospective action are in 2.30. Plans will want to evaluate their CTM data. CMS assessed the change using 2019 CTM data from the 2021 Star Ratings. When including category 1.30 complaints, there was an increase in the complaint volumes (numerator) for calculating the performance measure. CMS found a decrease in stars for almost one-quarter of plans.
There are also changes to Star Ratings included in the Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs [CMS-4192-P] proposed rule released on January 12, 2022. Comments for this rule are due March 7, 2022. To view the proposed rule, please visit: https://www.federalregister.gov.
Other measures have proposed changes and CMS is seeking comments. Some proposals, such as those relating to health equity and social determinants of health, will take some time to implement.
Comments on the Advanced Notice are due to CMS by March 4, 2022. We encourage you to review these changes and the potential impact to your current processes or changes needed in the future.
To view the 2023 Advance Notice, please visit: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Announcements-and-Documents and select 2023.
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