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Changes to Star Ratings Methodology in 2021 Medicare Advantage and Part D Final Rule

This Bulletin is brought to you by AHLA’s Payers, Plans, and Managed Care Practice Group.
  • June 25, 2020
  • Lauren E. Parisi , McDermott Will & Emery LLP

In the Final Rule, the uncertainty around the COVID-19 pandemic’s impact on the health care system has only partially deterred CMS from making changes to the Star Ratings system. In the February 2020 proposed rule (Proposed Rule), which predated the point at which the COVID-19 pandemic began to have a tangible impact in the United States, CMS made numerous proposals related to Star Ratings. CMS finalized several of these proposals, all of which, except for one, will be effective for the 2023 Star Ratings and correspond to the 2021 performance period. CMS will remove the Rheumatoid Arthritis Management measure; convert the classification of the Statin Use in Persons with Diabetes (SUPD) measure from an intermediate outcome measure to a process measure; and increase the weight of patient experience and complaints measures and access measures in the calculation of overall Star Ratings. CMS also will remove outliers using the Tukey outer fence outlier deletion statistical method for the 2024 Star Ratings, corresponding to the 2022 performance year. This methodology will remove measure scores above and below certain cutoffs before the calculation of cutpoints, which increases stability and predictability and limits the impact of outlier scores on the overall ratings system.

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