loading…
loading…
loading…
97
that begins with a request for reconsideration. This review is not intended to repeat the preview periods in giving contracts another opportunity to raise general questions about how CMS calculates the Star Ratings, nor is it intended to review how every measure was calculated. Instead, this review affords an MA organization the opportunity to request review of specific measure values and stars that may affect the calculation of the contract’s QBP status. As described at §§ 422.164(h) and 423.184(h), CMS annually sets and announces a deadline for MA and Part D organizations to request that CMS or the Independent Review Entity (IRE) review its appeals data or CMS review its Complaints Tracking Module (CTM) data. For the 2026 Star Ratings, CMS is announcing the following deadlines: • May 30, 2025 for all contracts to request a review of 2024 CTM data. Sponsors should refer to the January 6, 2025, HPMS memorandum, “Updated Complaints Tracking Module Standard Operating Procedures,” for instructions on submitting a Plan Request in HPMS to request a review of CTM complaint(s). • June 30, 2025 for all contracts to request a review of 2024 appeals data. Sponsors can view and monitor their Part C appeals timeliness and effectuation compliance data on the Medicare Appeal Search website. For the 2027 Star Ratings: • CMS finalized a deadline of May 18, 202625 for all contracts to request a review of their administrative data used for the Part D Patient Safety Star Ratings measures26 for the 2025 measurement year for the 2027 Star Ratings. CMS reports the Patient Safety measures through the Patient Safety Analysis Web Portal each month to Part D sponsors. Sponsors should review their underlying measure data in the monthly reports and alert CMS if any potential issues are identified in the rate calculations per the measure specifications. Sponsors should refer to the annual HPMS memorandum released each April, “Information to Review Data Used for Medicare Part C and D Star Ratings and Display Measures,” which describes the process of submitting the requests.27 We also encourage sponsors to submit requests for review of their administrative data for the Part
25 Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly. https://www.federalregister.gov/documents/2024/04/23/2024-07105/medicare-program-changes-to-the-medicare-advantage-and- the-medicare-prescription-drug-benefit. 26 Includes Medication Adherence for Cholesterol (Statins) (ADH-Statins), Medication Adherence for Hypertension (RAS Antagonists) (ADH-RAS), Medication Adherence for Diabetes Medications (ADH-Diabetes), Statin Use in Persons with Diabetes (SUPD), Concurrent Use of Opioids and Benzodiazepines (COB), and Polypharmacy: Use of Multiple Anticholinergics (ACH) Medications in Older Adults (Poly-ACH) measures. 27 April 11, 2024 HPMS memorandum, Information to Review Data Used for Medicare Part C and D Star Ratings and Display Measures.