Impact on CMS 2020 Final Rule

In the midst of the COVID-19 global pandemic, the Center for Medicare & Medicaid Services (CMS) issued a final rule that implements a subset of the proposals from the February 18, 2020, proposed rule (85 FR 9002) related to Part-C and Part-D  measures. These changes included:

• Not requiring HEDIS and CAHPS measure submission for 2020
  • They will replace the CMS 2020 Star Rating Measures based the on the HEDIS and CAHPS data from 2019.
• Remove the Part-C Rheumatoid Arthritis measure
• Modify the classification of the Statin Use in Persons with Diabetes (SUPD) from an intermediate outcome measure to a process measure

 CMS announced they would change the weight of the Member Experience/Complaints measure categories -- to a weight of 2 to 4. 

Every year CMS makes adjustments to Star Ratings for Medicare Advantage, but this year’s change is particularly notable for a policy shift on the part of CMS.  It’s easy to overlook this change in the middle of all the hubbub around covid-19, but one should pay attention because it demonstrates a change in CMS’s thinking around Stars priorities.  Later this week look for a blog from BHA with a predictive worksheet that will help you to determine the impact of weight changes to the Member Experience/Complaints changes.