Medicare Advantage insurers won a victory as CMS agreed to recalculate Star Ratings following lawsuits from SCAN Health Plan and Elevance Health alleging improper calculations. Star Ratings inform beneficiaries of plan quality and impact funding, with higher ratings receiving more funding. CMS updated how Star Ratings are calculated using the Guardrail Rule to cap cut point changes and the Tukey Outlier Rule to remove extreme outliers. Following lawsuits, Star Ratings were recalculated, resulting in a $250 million revenue swing for SCAN. This decision raises questions about the future of Star Ratings and leads to increased scrutiny on CMS and their rule implementation.
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Why Insurers Beat CMS In the MA Star Ratings Battle
