Medicare Advantage star ratings may change to address fairness complaints

From: Modern Healthcare

By Virgil Dickson

Top CMS officials signaled this week that the agency will consider altering Medicare Advantage quality ratings to adjust for socio-economic characteristics of a plan’s enrollees.

Health plans that primarily serve low-income members and people who are dually eligible for Medicare and Medicaid complain they unfairly get lower star ratings that make them ineligible for bonuses and put them 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.

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