Stars News: Clover Gets Special Treament; Alignment Sues
Coming off of Thursday’s 2027 Star Ratings release, two major developments have occurred: (1) Clover Health got special treatment in Star Year (SY) 2027 calculations and (2) Alignment Healthcare is suing the Centers for Medicare and Medicaid Services (CMS) over its 2027 ratings.
In a release, Clover Health noted that CMS calculated its 2027 Star rating for its PPO plan by excluding the 20 measures a judge struck in Clover’s 2026 Star Ratings lawsuit. It was the only Medicare Advantage (MA) contract to get such treatment. All others were rated on all 45 measures. CMS hid the change from other plans until it became known in the Clover release. Clover received a 5.0 rating for the contract.
Alignment Healthcare sued CMS today over its 2027 ratings, alleging they were determined “in flagrant violation” of statute. Alignment has filed in the same federal court in the District of Columbia it is litigating its 2026 ratings. Alignment says CMS “has completely departed from Congress’s vision of leveraging predictable, valid measures developed with input from providers, plans, and the public.” It argues many of the same things it has been putting forth in its 2026 suit, including regulatory violations. In the Clover case, a judge struck 10 measures for statutory reasons and 10 for regulatory deficiencies.
Just 25% of Alignment’s members would now be in plans with 4 or more stars for 2027, down from 100% in 2026. Alignment says it will lose more than $200 million due to CMS’ faulty calculations.
Modern Healthcare also has winners and losers in terms of Star Years 2027.
Additional articles: https://www.fiercehealthcare.com/payers/alignment-healthcare-sues-cms-over-its-2027-medicare-advantage-star-ratings and https://www.modernhealthcare.com/insurance/mh-alignment-health-star-ratings-medicare-advantage/ and https://www.modernhealthcare.com/insurance/mh-medicare-advantage-star-ratings-2027-cms/
#cms #medicareadvantage #quality #stars
https://www.modernhealthcare.com/insurance/mh-cms-clover-health-medicare-advantage-2027
— Marc S. Ryan
