The Federal Financial Forum

From: HealthcareDIVE

By Heather Caspi

Dive Brief:

• The CMS recently released its intent to develop a star-rating system specifically for health plans established under the Financial Alignment Initiative, which aims to improve the experience for dual Medicare-Medicaid enrollees and align the financial incentives of the programs.
• The announcement came out in a notice this month to those plans participating in the state-administered demonstrations, Modern Healthcare reports.
• The notice details how the agency plans to structure the rating system and what measures would be factored into the ratings.

Dive Insight:

When, or even whether, the ratings will be created remains undetermined.

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From: OpenMinds

In a recent update to the Medicare Hospital Compare ratings,  the number of hospitals awarded the maximum five stars dropped by about one-third, from 336 in July 205 to 207.  The update added hospital scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) to the ratings for the second time; the first was in April 2015.

From: AIS Health

By James Gutman

In the course of less than a day and a half Oct. 19 and 20, CMS seemingly changed the entire mindset of many Medicare insurers serving highly disadvantaged populations from despair to cautious optimism. Its two top officials did that in separate presentations at a major industry conference that put a different interpretation on the results of new research it has conducted than did lower officials who unveiled the results of at least one piece of the new research at a Sept. 10 CMS conference. The change, as one top-level executive of a Medicare Advantage (MA) insurer put it at the later conference, was “pretty amazing.”

From: ProPublica

by Allegra Abramo and Jennifer Lehman, special to ProPublica

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SentosaCare homes, which took in nearly $538 million from Medicare and Medicaid in 2013, aren’t the only facilities in the state with repeat violations and low staffing, and several of the company’s homes have above-average ratings on Medicare’s Nursing Home Compare web site, which rates them with one to five stars. (State-by-state inspection reports can be searched on ProPublica’s Nursing Home Inspect, which also lists deficiencies by severity level.)

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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