Introduction to the Ratings Dispute
TALLAHASSEE — Siding with federal health agencies, a U.S. district judge has rejected arguments by the insurer Florida Blue that key quality ratings didn’t properly take into account disruptions caused by heavy flooding in 2023 in Broward County.
Background of the Case
Washington, D.C.-based Judge Amit Mehta issued a 19-page ruling Friday in a lawsuit filed in December by Florida Blue, formally named Blue Cross & Blue Shield of Florida. The insurer contended that lower federal ratings would cause it to lose tens of millions of dollars and could affect seniors’ health-plan enrollment decisions.
The Star Ratings System
The case centers on Medicare Advantage plans and a Medicare prescription-drug plan offered by Florida Blue and on what is known as the federal Star Ratings system. Federal officials rate health plans on a five-star scale, with the ratings tied to financial incentives and released to the public.
Extreme and Uncontrollable Circumstances Rule
Florida Blue contended that the U.S. Department of Health and Human Services and the federal Centers for Medicare & Medicaid Services should have made adjustments to the company’s ratings to account for disruptions to health services during April 2023 flooding in Broward County. A federal rule, known as the “extreme and uncontrollable circumstances rule,” is designed to allow plans to avoid being penalized in the ratings system because of emergency situations. But for the rule to be triggered, the secretary of the Department of Health and Human Services must declare a public health emergency — something that then-Secretary Xavier Becerra did not do because of the Broward County floods.
Impact of the Flooding
Broward’s historic flooding caused more than $100 million in losses, major damage to 1,095 homes, and job layoffs. The lawsuit challenged the rule under what is known as the federal Administrative Procedure Act, including arguing that the rule was “arbitrary and capricious” because its use depends on the subjective decision-making of the secretary, Mehta wrote.
Court Ruling
But Mehta rejected the argument, saying it “overlooks that CMS (the Centers for Medicare & Medicaid Services) did not intend for the rule to create a broad exception for Star Ratings adjustments. Rather, CMS sought to ensure that only a narrow set of the most affected contracts benefited from the rule.” “Given the rule’s narrow purpose, it was not arbitrary and capricious for CMS to tie the rule’s application to the secretary’s discretionary declaration of a public health emergency,” Mehta wrote. “That condition is consistent with the statutory scheme.”
Conclusion
Without the requested adjustments, Florida Blue said in the lawsuit that its Medicare Advantage HMO and a prescription-drug plan received lower-than-justified scores in ratings released in October. The lawsuit said data showed “substantial declines in doctor visits and prescription refills by members at the time the flooding took place in Broward County.” The Centers for Medicare & Medicaid Services, which is part of the Department of Health and Human Services, used 2023 performance data in determining plan ratings for 2025. Those ratings were released in October, the lawsuit said. While Becerra did not issue a public-health emergency because of the flooding, Gov. Ron DeSantis issued an emergency declaration and then-President Joe Biden declared a major disaster.
FAQs
- What was the main argument made by Florida Blue in the lawsuit?
Florida Blue argued that the federal ratings did not properly take into account disruptions caused by heavy flooding in 2023 in Broward County. - What is the Star Ratings system?
The Star Ratings system is a federal system that rates health plans on a five-star scale, with the ratings tied to financial incentives and released to the public. - What is the extreme and uncontrollable circumstances rule?
The extreme and uncontrollable circumstances rule is a federal rule that allows plans to avoid being penalized in the ratings system because of emergency situations, but it requires the secretary of the Department of Health and Human Services to declare a public health emergency. - How much did the flooding in Broward County cause in losses?
The flooding in Broward County caused more than $100 million in losses, major damage to 1,095 homes, and job layoffs. - What was the outcome of the lawsuit?
The U.S. district judge rejected Florida Blue’s arguments and sided with federal health agencies, ruling that the extreme and uncontrollable circumstances rule was not arbitrary and capricious.
