03/31/2022

Quality Measure Rating Threshold Changes with the April 2022 refresh

In March 2019, the Centers for Medicare & Medicaid Services (CMS) released memorandum QSO-19-08-NH, which outlined a plan to update the quality measure (QM) rating thresholds every six months. The plan was to increase the thresholds by 50% of the average rate of improvement in QM rating scores. For example, if there is an average rate of improvement of 2%, the QM rating thresholds would be raised 1%. Similar to setting new thresholds, this action also aims to incentivize continuous quality improvement. Additionally, it will reduce the need to have larger adjustments to the thresholds in the future. The initial threshold changes were scheduled to occur in April 2020 but were put on hold due to the COVID-19 Public Health Emergency. CMS plans to implement the QM threshold changes with the April 2022 refresh. At that time, CMS will also release a new Five-Star Quality Rating System Technical Users Guide with the updated QM rating thresholds.

Raising the QM thresholds effectively “moves the goalposts” for providers striving to improve their QM star ratings, and may have impacts on systems that depend on the QM scores, including the quality incentive payment portion of Ohio Medicaid reimbursement. Questions related to this change may be directed to Stephanie DeWees at sdewees@leadingageohio.org or Susan Wallace at swallace@leadingageohio.org.