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CMS Proposes New Star Ratings for Dual Demo Plans

Aimee Sharp
Author | Shield HealthCare
11/16/15  8:54 AM PST
Dual Demo Plans

By Virgil Dickson for Modern Healthcare

The CMS is working to develop a separate star-rating system for health plans participating in an Obama administration experiment intended to better manage benefits and care for low-income and disabled Americans.

In a Nov. 6 notice sent to plans (PDF) participating in state-administered demonstrations, the CMS outlines how the star system would be structured and what quality measures would be included.

However, the ratings would only be created if the CMS decides to expand the initiative, and that will only happen if the demonstrations actually improve the quality of care for beneficiaries and save money.

There is no timeline for such a decision. It will be years before the agency has collected enough data to determine whether the results warrant expanding the program. Until then, the CMS plans to post quality performance data, including how dual plans compare with one another, starting next year on the Medicare-Medicaid Coordination Office website.

Although participating health plans say they generally support the idea of a unique rating system, some are concerned that the CMS won’t get it right.

“The challenge CMS faces is to create a rating system that accurately reflects the needs of individuals and delivery of care across the two programs,” Cigna spokeswoman Katie Sulkowski said.

Twelve states have rolled out three-year demonstrations under the Affordable Care Act program, called the Financial Alignment Initiative. The goal of the program is to better coordinate the health benefits provided to Americans who are eligible for both Medicare and Medicaid and as a result receive splintered care at extremely high costs to both programs.

Read the Full Article at Modern Healthcare.


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