For an affected contract that has missing data in the current or previous year, the final measure rating comes from the current year unless any of the exemptions described in paragraphs (i)(2)(ii), (i)(3)(ii), and (i)(4)(ii) of this section apply. New measures to the Star Ratings program will receive a weight of 1 for their first year in the Star Ratings program. (ii) The Part C improvement measure is not included in the count of the minimum number of rated measures. (j) Special rules for 2021 Star Ratings only. We use the start date of the incident period to determine which year of Star Ratings could be affected, regardless of whether the incident period lasts until another calendar year. The Centers for Medicare & Medicaid Services (CMS) has enhanced its Nursing Home Compare public reporting site to include a set of quality ratings for each nursing home that participates in Medicare or Medicaid. (iii) A contract is assigned 3 stars if it meets at least one of these three criteria: (A) Its average CAHPS measure score is at or above the 30th percentile and lower than the 60th percentile, and it is not statistically significantly different from the national average CAHPS measure score; or, (B) Its average CAHPS measure score is at or above the 15th percentile and lower than the 30th percentile, the reliability is low, and the score is not statistically significantly lower than the national average CAHPS measure score; or. (i) The method maximizes differences across the star categories and minimizes the differences within star categories using mean resampling with the hierarchal clustering of the current year's data. Contracts affected by extreme and uncontrollable circumstances do not have the option of reverting to the prior year's improvement rating. (D) An MA-only contract may be adjusted only once for the CAI for the Part C summary rating. This rating-specific factor is added to both the summary and overall ratings of contracts that qualify for the reward factor based on both high and stable relative performance for the rating level. (iv) For an affected contract with at least 25 percent of enrollees in FEMA-designated Individual Assistance areas at the time of the extreme and uncontrollable circumstance, the contract receives the higher of the previous year's Star Rating or the current year's Star Rating (and corresponding measure score) for each CAHPS measure. The Medicare enrollment data would be aggregated from MA contracts that had at least 90 percent of their enrolled beneficiaries with mailing addresses in the 10 highest poverty states. A Guide to the CMS Nursing Home Staffing Star Rating - StarPRO (B) CMS may disable the Medicare Plan Finder online enrollment function (in Medicare Plan Finder) for Medicare health and prescription drug plans with the low performing icon; beneficiaries will be directed to contact the plan directly to enroll in the low-performing plan. (i) An affected contract must report HEDIS data unless exempted under paragraph (i)(4)(ii) of this section. New measures that have been in the Part C and Part D Star Rating program for 3 years or less use the hierarchal clustering methodology with mean resampling with no guardrail for the first 3 years in the program. (A) The adjustment factor is monotonic (that is, as the proportion of LIS/DE and disabled increases in a contract, the adjustment factor increases in at least one of the dimensions) and varies by a contract's categorization into a final adjustment category that is determined by a contract's proportion of LIS/DE and disabled beneficiaries. CMS Trends in Part C and D Star Rating Measure- Cut Points - HHS.gov The count of beneficiaries for a contract is restricted to beneficiaries that are alive for part or all of the month of December of the applicable measurement year. (1) Reward factor. Special rules for 2021 and 2022 Star Ratings only. (iii) An affected contract with an exemption described in paragraph (i)(2)(ii) of this section receives the contract's CAHPS measure stars and corresponding measure scores from the prior year. PDF Five Star State-Level Cut Point Table - Updated August 2020 - HHS.gov The Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Advantage (Medicare Part C) and Medicare Part D Star Ratings each year to measure the quality of health and drug services received by consumers enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans). Subject to paragraphs (e)(2) and (3) of this section, CMS will assign weights to measures based on their categorization as follows. (ii) The measure-level change score calculation described at 423.184(f)(4)(i) is not applied for CAHPS measures and the measure-level change score used for the 2020 Star Ratings is applied in its place for all CAHPS-based measures. (i) CMS excludes the numeric values for affected contracts with 60 percent or more of their enrollees in the FEMA-designated Individual Assistance area at the time of the extreme and uncontrollable circumstance from the determination of the performance summary and variance thresholds for the Reward Factor described in paragraph (f)(1) of this section. (iv) When a contract is an affected contract with at least 25 percent of enrollees in FEMA-designated Individual Assistance areas at the time of the extreme and uncontrollable circumstance with regard to separate extreme and uncontrollable circumstances that begin in successive years, it is a multiple year-affected contract. The Star Ratings used in this calculation are the rounded stars (to the whole or half star) that are publicly displayed on www.medicare.gov. (A) Improvement scores of zero or greater would be assigned at least 3 stars for the improvement Star Rating. To sign up for updates or to access your subscriber preferences, please enter your contact information below. (4) 5-Star Scale. 42 CFR 422.166 - Calculation of Star Ratings. (ii) In determining the CAI values, a measure will be excluded from adjustment if the measure meets any of the following: (A) The measure is already case-mix adjusted for socioeconomic status. Icons are displayed on Medicare Plan Finder to note performance as provided in this paragraph (h)(1): (i) High-performing icon. (iv) The provisions of 422.164(g)(1) and (2) are not applied for the failure to submit HEDIS and CAHPS-based measures. (2) Clustering algorithm for all measures except CAHPS measures. The data to develop the model will be limited to the 10 states, drawn from the 50 states plus the District of Columbia with the highest proportion of people living below the FPL, as identified by the 1-year ACS estimates. (v) For an affected contract with at least 25 percent of enrollees in FEMA-designated Individual Assistance areas at the time of the extreme and uncontrollable circumstance, the affected contract receives the higher of the previous year's Star Rating or the current year's Star Rating (and corresponding measure score) for each HEDIS measure. (iii) CMS adjusts the measures listed in paragraph (i)(6)(ii) of this section using the adjustments listed in paragraph (i)(6)(i) of this section for contracts affected by extreme and uncontrollable circumstances where there are continuing communications issues related to loss of electricity and damage to infrastructure during the call center study. (i) CMS excludes the numeric values for affected contracts with 60 percent or more of their enrollees in the FEMA-designated Individual Assistance area at the time of the extreme and uncontrollable circumstance from the clustering algorithms described in paragraph (a)(2) of this section. (1) Medicare Plan Finder performance icons. (D) The QBP ratings are updated for any changes in a contract's parent organization that are reflected in CMS records prior to the release of the final QBP ratings in April of each year. (iv) Access measures receive a weight of 4. That's a critical question every health plan has to contend with; the answer can have a significant impact. (iv) Contracts that do not have an exemption defined in paragraph (i)(4)(ii) of this section may contact National Committee for Quality Assurance (NCQA) to request modifications to the samples for measures that require medical record review. (A) The adjustment factor is monotonic (that is, as the proportion of LIS/DE and disabled increases in a contract, the adjustment factor increases in at least one of the dimensions) and varies by a contract's categorization into a final adjustment category that is determined by a contract's proportion of LIS/DE and disabled beneficiaries. The Department may not cite, use, or rely on any guidance that is not posted An official website of the United States government. Effective for the Star Ratings issued in October 2022 and subsequent years, CMS will add a guardrail so that the measure-threshold-specific cut points for non-CAHPS measures do not increase or decrease more than the value of the cap from one year to the next. The higher rating is used for the highest rating. (iii) The clustering algorithm for the improvement measure scores is done in two steps to determine the cut points for the measure-level Star Ratings. CMS will determine cut points for the assignment of a Star Rating for each numeric measure score by applying either a clustering or a relative distribution and significance testing methodology. Star Ratings is a program operated by the Centers for Medicare and Medicaid Services or CMS and is based on relative quality and performance at contract level - not plan level.1 It is the tool that measures a Medicare enrollee's experience with a health plan and their health care system. New measures that have been in the Part C and D Star Rating program for 3 years or less use the hierarchal clustering methodology with mean resampling with no guardrail for the first 3 years of the program. Special rules for the 2022 Star Ratings only. The method combines evaluating the relative percentile distribution with significance testing and accounts for the reliability of scores produced from survey data; no measure Star Rating is produced if the reliability of a CAHPS measure is less than 0.60. (A) Part C Call CenterForeign Language Interpreter and TTY Availability. Before sharing sensitive information, make sure youre on a federal government site. (D) A PDP contract may be adjusted only once for the CAI for the Part D summary rating. The low performing icon is calculated by evaluating the Part C and Part D summary ratings for the current year and the past 2 years. For affected contracts with at least 25 percent of enrollees in a FEMA-designated Individual Assistance area at the time of the extreme and uncontrollable circumstance, CMS holds the affected contract harmless by using the higher of the contract's summary or overall rating or both with and without including all of the applicable new measures.
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