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CMS may revise quality-rating system for Medicare Advantage

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Top CMS officials  are indicating that it will consider revising Medicare Advantage quality ratings to adjust for socio-economic characteristics of a plan’s enrollees.

Plans with heavy enrollments of   low-income members and people are dually eligible for Medicare and Medicaid  have been complaining that they unfairly get lower star ratings. These ratings make them ineligible for bonuses and could result in their losing Medicare contracts. The CMS can throw out a  plan if it has fewer than three stars for three consecutive years.

“Our partners in Medicare Advantage need to have proper incentives to care for dual-eligibles and lower socio-economic status individuals,” acting CMS Administrator Andy Slavitt said Monday.

“Our research shows that there are statistically significant results for low-income and disabled beneficiaries in certain measures. We are now considering what the appropriate policy responses should be to these findings.”

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