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Analysis

CMS Expands Star Ratings for Exchange Health Plans

By John Commins  
   August 15, 2019

Starting with the 2020 enrollment period, Health Exchange plans in every state will be graded on a five-star quality rating.  

Health plans offered on the Health Insurance Exchanges will be required in the 2020 enrollment period to post their grades on a five-star Quality Rating System, under a mandated announced Thursday by the Centers for Medicare & Medicaid Services.

"Knowledge is power, and for the first time, consumers will have access to meaningful, simple-to-use information to compare the quality, along with the price, of health plans on Exchange websites, including HealthCare.gov," CMS Administrator Seema Verma said in a media release.

"This addresses our strongly held commitment to equip consumers with the tools they need to find the best choice possible. Increasing transparency and competition drive better quality and cost, with consumers benefitting the most, " Verma said.

The overall star rating is based on three categories: Medical Care, Member Experience and Plan Administration. The ratings will address factors including how enrollees rate the doctors and the care they receive in the plan's network, how well the network providers coordinate care with enrollees and doctors, administrative competence, customer service, and access to personal health information. 

CMS operated a pilot five-star ratings on HealthCare.gov in Virginia and Wisconsin during the 2017 and 2018 enrollment periods. The pilot was expanded to Michigan, Montana, and New Hampshire during the 2019 enrollment period.

The ratings system has the blessing of America's Health Insurance Plans, which said in a statement that "the nationwide expansion of the health quality measures is a positive step to help consumers review and select a plan that fits their needs for the year."

The Blue Cross Blue Shield Association said its member companies would "continue to work with CMS on ensuring that the information is displayed in a manner that is meaningful for patients when making selections during Open Enrollment this fall."

CMS is posting star ratings and quality measure level data from the 2019 Plan Year in a Public Use File. The star ratings data for the 2020 Plan Year will be released closer to open enrollment, which runs from Nov. 1, to Dec. 15, 2019. 

“Knowledge is power, and for the first time, consumers will have access to meaningful, simple-to-use information to compare the quality, along with the price, of health plans on Exchange websites, including HealthCare.gov.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

The overall star rating is based on three categories: Medical Care, Member Experience and Plan Administration.

The ratings will address factors including how enrollees rate the doctors and the care they receive in the plan's network, how well the network providers coordinate care with enrollees and doctors, administrative competence, customer service, and access to health information.


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