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February 26, 2019

CMS will resume terminating low-performing MA, Part D plans

Daily Briefing

    CMS in a memo sent earlier this month to Medicare Advantage (MA) and Medicare Part D insurers said it will resume its practice of terminating MA and Part D plans that consistently receive poor quality ratings.


    CMS prior to 2016 was able to bar MA plans that consistently received poor quality scores from participating in the program. However, lawmakers included a provision in the 21st Century Cures Act, which was enacted in December 2016, that prohibited CMS from terminating MA plans because of poor quality scores through 2018. Federal lawmakers last year tried to extend that provision through 2027 as part of a federal funding bill, but failed.

    CMS to resume terminating low-performing MA plans

    Now that the provision has expired, CMS in the memo wrote that it is resuming its practice of terminating low-performing MA plans from the program.

    CMS said it could terminate plans that have failed to receive a summary quality rating of at least three stars for three consecutive years, starting this year. CMS wrote, "the 2020 Star Ratings, issued in the fall of 2019, will be the first set of ratings where performance below three stars would be counted toward qualifications for termination." As such, the earliest an MA plan could be terminated from the program is 2022.

    CMS in the memo said it will follow similar guidelines for terminating Part D plans (Owens, "Vitals," Axios, 2/19; CMS memo, 2/6; Haefner, Becker's Hospital Review, 2/19).

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