CMS proposes raising Medicare Advantage marketing, ratings stakes

The Centers for Medicare and Medicaid Services is considering significant changes to how Medicare Advantage quality is measured, how provider networks are assembled and how insurance companies market their products.

In a draft regulation published Wednesday, CMS proposes a variety of changes to Medicare Advantage for next year, including modifications to the Star Ratings bonus payment program, which the agency projects would save nearly $25 billion over 10 years.

CMS wants to eliminate the “reward factor” that gives higher annual ratings to carriers that consistently perform well over time. In its place, CMS aims to establish a health equity index that would encourage Medicare Advantage insurers to identify beneficiaries who have disabilities, receive low-income subsidies or are dually eligible for Medicare and Medicaid, and create programs to improve health outcomes for them.

In addition, CMS proposes reducing the weight of patient experience and complaints when calculating the ratings. The agency doubled the effect of those metrics this year, which insurance companies say contributed to an industrywide drop in scores.

The regulator also is taking aim at marketing practices that have attracted negative attention. The number of consumer “marketing misconduct” complaints surged to more than 39,600 last year, a 157% increase from 2020, according to federal data CMS provided to Modern Healthcare. Marketers argue the number of complaints is small relative to the 29.5 million people with Medicare Advantage.

The agency expects the complying with these marketing rules would require a one-time, $172,000 expense per insurer.

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Ref: Modern Healthcare