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  • Washington Highlights

    CMS Proposes Adjustment for MA Star Rating to Account for Sociodemographic Factors

    Len Marquez, Senior Director, Government Relations

    The Centers for Medicare and Medicaid Services (CMS) Feb. 20 released advance notice of methodological changes for calendar year (CY) 2016 to adjust Medicare Advantage (MA) capitation rates.

    One proposal aims to modify the calculation of star ratings to account for plans that serve large populations of disadvantaged patients. Under the proposal, CMS would reduce the weight by 50 percent for seven of the 46 total measures where performance was associated to sociodemographic status (SDS) factors.

    In a follow up release, CMS explained that they sought “to provide relief to plans serving large numbers of dual or LIS [low-income subsidiary] beneficiaries while (they) conduct additional research into what is driving the association.” CMS also stated that this adjustment was an interim step, and is considering additional changes to measures affected by patient SDS characteristics.

    Adjustment for SDS in performance measures has been a widely discussed issue. The National Quality Forum (NQF) is currently running a trial period to see the impact of adjusting for SDS for certain measures. In a letter to CMS about a star rating system for hospitals (see related story) the AAMC asked the agency to exclude those measures that are under review in the NQF’s SDS trial period. The AAMC argued that performance for these measures would be inaccurately portrayed without an appropriate SDS adjustment.

    Comments on the CMS MA plan proposal are due March 6.