behavioralhealth

2024 Star Ratings Turmoil Creates Huge Vulnerability for Medicare Advantage Plans

While the Medicare Advantage (MA) Star Program has always made it difficult for plans to achieve and maintain high Star scores, the Star roller coaster ride has been much more profound over the past several years.  We now have had two years of pretty bad news, which puts a blemish on the program (fair or not). What’s more, the percentage of high-scoring contracts and the percentage of enrollment in them are now below pre-COVID years.  To refresh a bit on this, during the COVID pandemic, the Centers for Medicare and Medicaid Services (CMS) created fairly major calculation allowances for both Star 2021 (2019 and 2020 data) and 2022 (2020 and 2021 data). These allowances had the effect of boosting Star scores. We saw a surge in Star scores in 2022, including for plans that historically did not have a great track record of consistently hitting 4 Stars and above.  However,

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November 15, 2023

Great Series on America’s Long-Term Care Problem Congratulations to the Kaiser Family Foundation and The New York Times on the first in a series of articles on America’s long-term care crisis. America needs an aging policy. The series shows real-life examples of the impact of not having a national agenda on aging. It clearly shows that the lack of adequate supports for the elderly also impacts other generations, including children’s loss of income to take care of an elderly loved one. In my book (available for purchase on this website), I devote a chapter to aging and recommend ways to make services available to all in an income-based buy-in strategy. Not addressing aging will only drive long-term care and medical costs even higher in the future. In addition to the NYT story and press release at the link below, here is a link to the KFF summary of a survey

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Major Changes in Medicare Advantage Oversight

The Centers for Medicare and Medicaid Services (CMS) have been active this year proposing major new restrictions on Medicare Advantage (MA) plans. Many of the changes are in reaction to provider lobbying efforts on Capitol Hill as well as public outcry over misleading tactics by third-party entities who enroll individuals in the popular senior and disabled plans. Let’s start out with the changes effective January 1, 2024, from the 2024 MA and Part D rule finalized earlier this year.  It is important to note that CMS issued a memo that states that it will enforce the 2024 rule beginning January 1, 2024.  Usually, such rules are enforced through the regular program audit process and it takes a number of years before regulatory changes are rolled into the audit protocols.  That seemed fair as major changes take time for plans to implement.  But in the October 24, 2023, memo issued through

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