Calling all #healthcareleaders: CMS has announced significant adjustments to Medicare Advantage Star Ratings for 2024, which WILL impact Quality Bonus Payments in 2025.
In response to recent legal decisions, CMS will recalculate Star Ratings using 2023 actual cut points. This ensures that no contract will see a decrease in their Quality Bonus Payment Rating. Contracts that would have had lower ratings will maintain their current rating, while those with improved ratings can revise their 2025 bids.
This recalibration provides a critical opportunity to potentially increase compensatory bonuses based on improved star ratings.
Stay ahead of these regulatory changes and position your organization for success in the evolving healthcare landscape.
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Video Transcript:
Attention health plans and health care providers. CMS has announced a significant update that will impact Medicare Advantage Star ratings for 2024, with implications for your 2025 quality bonus payments. Following rulings in recent lawsuits, CMS will now recalibrate the Star ratings. Applying calculations from the 2023 actual cut points rather than those recalculated after excluding outliers.
This adjustment ensures [00:00:30] that no contracts quality bonus payment rating will decrease in the coming year. If a rating recalculated to be lower, the contract will be held harmless and retain its previous rating. Notably, Medicare Advantage contracts experiencing an increase in their star ratings will have the opportunity to revise their 2025 bids. Revisions include adjustments to bid pricing tools, plan benefit packages, and formularies. CMS has set tight deadlines for these submissions.
This recalibration and associated policy adjustments provide a critical window for health plans to potentially receive higher compensatory bonuses based on improved star ratings. Ensure your teams are prepared to navigate these updates and optimize your positions within this evolved regulatory context. Join us next week for another market minute.
