Details on CMS 2020 Announcment
Jordan Byrd On :
May 21 2020
On April 6, 2020 CMS announced significant to star ratings changes due to COVID-19:
- HEDIS uses 2018 Dates of Service for 2021 Star Ratings.
- CAHPS uses 2018 Dates of Service for 2021 Star Ratings.
- Possibly of foregoing a 2020 HOS survey and use last year's results for the 2022 and 2023 Star ratings.
In the April Call Letter, CMS confirmed the following measure and weight changes for 2021:
- D14: Statin Use in Persons with Diabetes (SUPD) increased from 1x to 3x
- Member Experience Measures increased from 1.5x to 2x. This includes the following measure:
- C22: Getting Needed Care
- C23: Getting Appointments and Care Quickly
- C24: Customer Service
- C25: Rating of Health Care Quality
- C26: Rating of Health Plan
- D07: Rating of Drug Plan
- D08: Getting Needed Prescription Drugs
- Non-HEDIS Measures
- C27: Care Coordination
- C28: Complaints about the Health Plan
- C29: Members Choosing to Leave the Plan
- C31: Plan Makes Timely Decisions about Appeals
- C32: Reviewing Appeals Decisions
- C33: Call Center – Foreign Language Interpreter and TTY Availability
- D01: Call Center – Foreign Language Interpreter and TTY Availability
- D02: Appeals Auto–Forward
- D03: Appeals Upheld
Moved to Display Page or Retired
- Adult BM Assessment (ABA)
- Will be removed
- Care for Older Adults –Functional Status Assessment Indicator (Part C)
- NCQA is moving forward with refining the hybrid specification for the Functional Status Assessment indicator in the Care for Older Adults measure. The measure will be moved to display for the 2022 and 2023 Star Ratings.
- Controlling High Blood Pressure (Part C)
- For measurement year 2020, NCQA is exploring modifying the timing of the denominator to look for two outpatient visits with a diagnosis of hypertension in the first six months of the measurement year or the year prior.
- Osteoporosis Testing in Older Women (Part C)
- The measure will be retired from the 2020 measurement year and will be removed from the display page starting in 2023. It keeps 2020 incurred dates of service. This is due to the difficulty of management for this measure.
- CMS noted several changes to other measures but deemed them “non substantial” and therefore the measures will not be removed from Star Ratings.
Potential Measures Concepts
- End-Stage Renal Disease (ESRD) Measures (Part C)
- Prior Authorizations (Part C).
- HOS Measures (Part C)
- Osteoporosis Screening (Part C)
- Cardiac Rehabilitation (Part C)
- Diabetes Overtreatment (Part C)
- Home Health Services (Part C)
- Generic Utilization (Part D)
- Initial Opioid Prescribing (IOP) Measures (Part D)
- Net Promoter Score (Part C &D)