CMS Final Rule Stars Program Update

Overview: Changes to STARS Program

On Jan. 15, The Centers for Medicare and Medicare Services (CMS) announced changes to Calendar Year (CY) 2022 Medicare and Medicaid Programs. On Jan. 19, the Federal Registrar published the Final Rule detailing those regulatory and measure level updates for the Stars program beginning in Measurement Year (MY) 2022. These changes will force health plans to reevaluate their Stars intervention strategies and better communicate to both providers and members. The recalibrated measure weighting toward CAHPS will also put more emphasis on member experience and prove pivotal to overall contract success. The final rule also includes changes to the Quality Bonus Payment Rules. The methodology outlined by CMS clarified that the enrollment figures used in the enrollment weighted QBP rating calculations are the Nov. enrollment in the year the Star Ratings are released. This new methodology will take effect during in the 2023 Quality Bonus Payment period. It’s important to remember that success in Stars is a continuous effort. But the health of a Stars program is critical to a health plan’s growth and sustainability. These new measures are complex and can require adjustments to your in-flight strategies. But don’t worry, you are not alone! ProspHire is adept at helping our clients quickly assess the impacts of CMS measure updates and developing strategies for continuous improvement. The recent changes are summarized below:

MeasuresDescription of Change
• Improving or Maintaining Physical Health
• Improving or Maintaining Mental Health
These measures will be retired to the Display Page for at least two years (beginning in MY2022); These measures will be retired at least for SY2024 and SY2025, with the earliest return to Star Ratings in SY2026 at a weight of 1, and Star Ratings in SY2027 and beyond will be a weight of 3
Medication Reconciliation Post Discharge (MRP)This measure will be retired as a standalone measure in MY2022, SY2024
Follow-up after Emergency Department Visit for Patients with Multiple Chronic Conditions (FMC)This measure will be added in MY2022, SY2024, with a permanent weight of 1 as a process measure
Controlling Blood Pressure Measure (CBP)This measure will be added beginning in MY2021, SY2023 with a 1x-weight, increasing to 3x-weight in MY2022, SY2024
Plan All-Cause Readmissions (PCR)This measure will be added in MY2022, SY2024 with a 1x-weight, increasing to a 3xc-weight in MY2023, SY2025
  1. MY = Measurement Year, the calendar year the measures are tracked and calculated for Star Ratings; SY = Star Year, the year that the official Star Ratings are received
  2. Source: CMS-provided information and documentation

ProspHire Is Here to Help

Unlike other improvement programs, when Stars interventions are executed, they do not always create savings. Many require reinvestment to drive continued improvement. Stars is also graded against a curve. What was good enough last year, may not be good enough the next. ProspHire excels at driving continuous improvement to optimize Stars performance. Through data driven analyses and clearly defined strategies, our team of seasoned subject matter experts implement interventions to increase Stars ratings and maximize rebate potential. Our practitioners have years of experience helping large MCOs enhance quality improvement programs. If you would like to learn more about the Stars Program or have any additional questions about how ProspHire can assist, let’s have a conversation!