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  • Washington Highlights

    CMS Will Not Use Star Ratings to Assess Plans in the Dual Eligibles Demonstration Program

    Len Marquez, Senior Director, Government Relations

    The Centers for Medicare and Medicaid Services (CMS) Nov. 6 announced that health plans participating in the financial alignment demonstration program for dual eligibles (beneficiaries who are eligible for both Medicare and Medicaid) will not immediately use a star rating system. Instead, beginning in 2016, these plans will have their quality data posted on the Medicare-Medicaid Coordination Office website.

    CMS stated that “while a new, fully mature star rating system will not be in place during the testing of the Medicare-Medicaid capitated financial alignment model, we intend to start work now to prepare for potential future expansion of the capitated financial alignment model.”

    The agency noted that their eventual goal is to transition into using a star rating system that meets the following criteria: measures quality of care across all Medicaid and Medicare services; meets the goals of the CMS quality strategy; emphasizes outcome measures; and be based on validated data, among other priorities. CMS is accepting public comments through Dec. 21, 2015 on the future star rating system for these plans.

    The Medicare-Medicaid demonstration started in 2011 and is taking place in 13 states.