Clover Health’s PPO, the company’s largest contract covering 97% of members, already secured a Medicare Advantage star ratings boost from 3.5 to 4.5 stars following litigation. Now, the insurer’s smaller HMO contract is also seeing a bump.
According to a June 17 regulatory filing, the star rating for Clover’s HMO contract rose to 4.5 stars from four.
The company previously filed a lawsuit challenging its lower star rating for the PPO contract, and a federal judge identified the improper inclusion of 20 measures. Originally, that Clover contract missed the general threshold for quality bonus payments.
If CMS raises the qualified payment bonus ratings for other MA plans, they have until June 22 to indicate interest in resubmitting bids.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
