Revise STAR ratings to add MH/SUD measures

MA provides healthcare coverage through private managed care plans for hospital and physician services as an alternative to traditional Medicare FFS. Enrollment in MA has continued to grow over the years and now accounts for more than 50 percent of Medicare enrollees. As enrollment continues to increase in the MA program, it’s critical for policymakers and regulators to fully understand any key differences in the ability to access care between MA and traditional Medicare FFS, including the ability to access care for MH/SUDs and the quality of the care that is delivered to MH/SUD patients.

CMS’ Star ratings are measures to help Medicare beneficiaries assess the performance of Medicare Advantage plans. The highest-performing plans can receive five stars. The rankings are based on a set of weighted measures, including services covered, administrative efficacy and service, and quality of care provided.[2] Not included in these measures is access to MH/SUD services, the quality of care received, or the degree to which MH/SUD care is integrated with physical health care.[1] Roughly a quarter of MA beneficiaries are enrolled in plans with access barriers, such as referral requirements, indicating a need for better plan reporting on MH/SUD treatment access and quality.[3] With about 20 percent of adults over 65 reporting symptoms of anxiety or depression, tools are needed to help beneficiaries pick a MA plan that best fits their care needs.[3] CMS should update its Star Ratings system to include measures that evaluate and track plans’ MH/SUD service accessibility and integration with physical healthcare.[1]