In a major example of a regulatory agency ignoring explicit regulations, the Centers for Medicare and Medicaid Services’ (CMS) TukeyGate ended in embarrassment for the agency, recalculation of 2024 Medicare Advantage Star scores, and resubmission of 2025 MA bids and benefits for winning plans.
About The Podcast:
Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.
Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.
Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.
Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.
Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.
Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.
About The Episode:
On this episode, Marc discusses TukeyGate. In a major example of a regulatory agency ignoring explicit regulations, the Centers for Medicare and Medicaid Servies’ (CMS) TukeyGate ended in embarrassment for the agency, recalculation of 2024 Medicare Advantage Star scores, and resubmission of 2025 MA bids and benefits for winning plans.
Key Takeaways:
CMS blatantly ignored regulations in calculating 2024 Star scores.
This was in an effort to save dollars and politically respond to concerns about Medicare Advantage overpayments.
Two federal judges recognized the error and ordered a recalculation for two plans.
CMS had no choice but to do so for all MA plans and reopen bids and benefits for 2025 for those who saw increased Star scores after recalculation.
CMS could come back and propose a number of other cost-savings in Star due to additional costs.
A health equity reward will already save dollars as of 2027.
CMS also could eliminate the quality improvement hold harmless for 4 and 4.5 Star plans as well as suspend for 1-year guardrails for Star cut points or eliminate them permanently.
Whether CMS does so immediately or not, changes will come and MA plans have to be ready on the quality improvement front.
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Resources
The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance
