Cigna gets win from CMS policy shift, but consumers may lose

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A revised policy on how star ratings are deducted from sanctioned Medicare Advantage plans will preserve millions of dollars in quality bonuses for Cigna--but some consumer advocates say the shift undermines health plans' accountability, Kaiser Health News reports.

The Centers for Medicare & Medicaid Services (CMS) said in a memo this week that it will no longer automatically reduce the ratings of plans that have four stars or more down to 2.5 stars when they face immediate sanctions. Insurers had said this policy was unfair, as considerably more plans now have four or more stars than when the policy was enacted.

The policy shift is a boon for Cigna, which CMS banned in January from selling or marketing new Medicare products after the agency found "substantial failures" in how it administered Part C and Part D plans, putting enrollees at risk.

Six of Cigna's Medicare Advantage plans, which it sells in 18 states, qualified for a quality bonus when CMS unveiled its 2016 ratings in October, KHN points out. Analysts estimate that Cigna's expected 2017 bonuses tied to star ratings will be $213 million to $350 million, and CMS' new policy means the insurer will still be eligible for those funds.  

But not everyone views the CMS policy reversal as good news.

"We are discouraged by CMS' announcement, which diminishes accountability and transparency related to plan sanctions," Stacy Sanders, federal policy director at the Medicare Rights Center, tells KHN.

There's also the concern that consumers don't get enough information about how Medicare Advantage plans are performing and whether they are being sanctioned, the article adds.

In fact, consumers had no way of knowing during the Medicare Advantage open enrollment period--which took place from Oct. 15 to Dec. 17--that Cigna's Medicare plans were being audited by CMS, as the agency did not publish its enforcement letter detailing its sanctions against the insurer until January.

Even so, CMS appears to be stepping up its enforcement actions against noncompliant Medicare plans, as it issued the highest-ever amount of civil monetary penalties for its 2015 program audits.

To learn more:
- read the KHN article

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