The CMS is now formally gearing up to develop a separate star rating system for health plans made up of enrollees that are dually eligible for Medicare and Medicaid.
The agency is looking (PDF) for companies to develop star rating measures for plans that are participating in a White House experiment intended to better manage benefits and care for low-income and disabled Americans.
Responses to the sources sought notice are due by March 17. Depending on responses, a formal request for proposals will be released.
Twelve states have rolled out three-year demonstrations under the Affordable Care Act program called the Financial Alignment Initiative. The goal of the program is to better coordinate the health benefits provided to Americans who are eligible for both Medicare and Medicaid and as a result receive splintered care at extremely high costs to both programs.
A separate rating system makes sense because dual plans cover a wider range of benefits than Medicare does, including Medicaid long-term supports and services and behavioral health services, said James Verdier, a senior fellow at Mathematica Policy Research, a nonpartisan research and policy evaluation organization.
The contractor will also help the CMS conduct an analysis of the impact of socio-economic factors on star ratings for Medicare Advantage plans and develop potential adjustments that may need to be made to the star system as a result.
The Affordable Care Act requires the CMS to make bonus payments to Medicare Advantage contracts based on a five-star rating system. Bonus payments are made to contracts that have a quality rating of four stars or higher.
Medicare Advantage plans that primarily serve low-income members and people who are dually eligible for Medicare and Medicaid say they unfairly get lower star ratings that make them ineligible for bonuses. They argue that these enrollees do not have the physical or mental capabilities to participate fully in managing their own health or to complete member satisfaction surveys. Both of those factors contribute to a plan's star rating.
Low ratings put these plans in danger of losing their Medicare contracts. The CMS has the statutory authority to boot a plan if it has fewer than three stars for three straight years.
