Four Elevance Health Medicare Advantage contracts will have higher 2024 star ratings because CMS updated the original ratings announced in October, according to a March 4 regulatory filing from the payer.
Elevance said that as a result, it estimates it will have approximately 49% of its Medicare Advantage members enrolled in plans rated at least four stars for 2024, according to the filing. The company said it estimates the financial benefit of the decision will be approximately $190 million for payment year 2025.
In the original ratings announced in October, the percentage of Elevance members enrolled in contracts rated at four stars or higher declined from 64% in 2023 to 34% for 2024. Three of the company's largest MA contracts by enrollment declined from 4.5 or four stars to 3.5 stars.
A CMS spokesperson told Becker's in March 5 statement that the agency "makes an administrative review process available to Medicare Advantage organizations for payment determinations based on the quality bonuses. MA organizations may request an administrative review of their ratings for Quality Bonus Program determinations and rebate retention allowances. Following the completion of an administrative review process, star ratings are updated as needed."
Elevance sued HHS in December for "unlawful, and arbitrary and capricious" methodology changes to how Medicare Advantage and Part D star ratings are calculated.
The lawsuit is focused on the "Tukey" method, a change announced by CMS in a 2020 final rule and implemented in 2024 star ratings. Through the new method, CMS removed extreme outliers from measure scores to prevent outliers from affecting all MA contracts, thereby making it more difficult for plans to earn a high star rating. In 2022, a final star ratings rule from CMS did not mention the new change, which the agency added back in the 2023 rule, citing an inadvertent removal. CMS limits scoring changes to 5% annually. In the lawsuit, Elevance says CMS should have factored in those limits before adding the Tukey change back in 2023 versus the other way around.