In a final flurry of activity under the Trump administration’s Department of Health & Human Services (HHS) leadership, the Centers for Medicare & Medicaid Services (CMS) released numerous final rules and other regulatory guidance last Friday, January 15.

As has been the case since CMS first codified Star Ratings in 2018, updates to Star Ratings measures and program guidelines were sprinkled throughout these documents.

The most noteworthy “new news” for Star Ratings from the combination of these newly released documents includes final codification of, among many other nuanced and detailed changes, the items listed below. We’ve summarized the impact all of these changes will have on current and future Star Ratings in a cheat sheet, available for download here.

Note: MY = Measurement Year, as in the year during which measures are tracked for Star Ratings. SY = Stars Year, as in the year ratings are received for the aforementioned measurement year.

Star Ratings Measure Additions

  • Addition of HEDIS® Controlling Blood Pressure measure (CBP) in MY2021/SY2023 with a 1x-weight, increasing to 3x-weight in MY2022/SY2024.
  • Addition of HEDIS® Plan All-Cause Readmissions measure (PCR) in MY2022/SY2024 with a 1x-weight, increasing to 3x-weight in MY2023/SY2025.
  • Addition of HEDIS® Transitions of Care (TRC) measure beginning in MY2022/SY2024, with a permanent weight of 1 as a process measure.
  • Addition of HEDIS® Follow-up after Emergency Department Visit for Patients with Multiple Chronic Conditions (FMC) measure beginning in MY2022/SY2024, with a permanent weight of 1 as a process measure.

Star Ratings Measure Retirements

  • Substantive changes to the 3x-weighted HOS measures of Improving or Maintaining Physical Health (IPH) and Improving of Maintaining Mental Health (IMH) will require these measures to be retired to the Display Page for at least 2 years (beginning in MY2022); these measures will be retired at least for SY2024 and 2025, with the earliest possible return to Star Ratings in SY2026 at a temporary weight of 1.
  • Confirmation that HEDIS® Medication Reconciliation after Discharge (MRP) will be retired as a standalone measure in MY2022/SY2024. (Guidance not provided regarding CMS’s planned treatment of MRP in MY2020 and MY2021 after NCQA retires MRP as a standalone measure.)

Other Noteworthy Announcements

  • CMS indicated any additional COVID-19 relief under the Extreme and Uncontrollable Circumstances (EUC) policy for MY2021/SY2023 will have to come through future rulemaking under the new administration.
  • CMS clarified the SY2022/MY2020 handling of the new specifications on the Medicare Plan Finder (MPF) within the lens of COVID-19 relief will be such that each contract’s summary/overall rating will be computed with and without that measure, and the option producing the higher rating will be the one used.
  • CMS confirmed nonsubstantive adjustments to the Statin Use in Persons with Diabetes measure (SUPD) to add an index prescription date for the 1st diabetes script and to codify new measure exclusions.
  • CMS confirmed continued allowability of face-to-face telehealth encounters for risk adjustment purposes while the COVID-19 public health emergency continues, which can also be used for HEDIS® exclusion data capture.

Finally, CMS offered updated perspective on a COVID measure, indicating that earliest possible addition date for a measure would be MY2024 (pursuant to measure development timeline requirements in previous rulemaking documents). CMS will also be gathering new pharmacy data for potential use in developing future Part D pharmacy quality measures.

Final Thought

Adapting Stars work plans, corporate strategic plans, and budget to cope with changes of this magnitude is challenging. If you need assistance adapting to these changes, we can help. From supporting scalable, efficient member engagement to helping develop a sustainable roadmap for improvement, our experts have deep expertise and can support your success. For more information, email me at melissa.smith@healthmine.com.