TALLAHASSEE \u2014 Siding with federal health agencies, a U.S. district judge has rejected arguments by the insurer Florida Blue that key quality ratings didn\u2019t properly take into account disruptions caused by heavy flooding in 2023 in Broward County.<\/p>\n
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\u2019 health-plan enrollment decisions.<\/p>\n
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. <\/p>\n
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\u2019s ratings to account for disruptions to health services during April 2023 flooding in Broward County. A federal rule, known as the \u201cextreme and uncontrollable circumstances rule,\u201d 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 \u2014 something that then-Secretary Xavier Becerra did not do because of the Broward County floods.<\/p>\n
Broward\u2019s 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 \u201carbitrary and capricious\u201d because its use depends on the subjective decision-making of the secretary, Mehta wrote.<\/p>\n
But Mehta rejected the argument, saying it \u201coverlooks 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.\u201d \u201cGiven the rule\u2019s narrow purpose, it was not arbitrary and capricious for CMS to tie the rule\u2019s application to the secretary\u2019s discretionary declaration of a public health emergency,\u201d Mehta wrote. \u201cThat condition is consistent with the statutory scheme.\u201d<\/p>\n
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 \u201csubstantial declines in doctor visits and prescription refills by members at the time the flooding took place in Broward County.\u201d 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.<\/p>\n
Introduction to the Ratings Dispute TALLAHASSEE \u2014 Siding with federal health agencies, a U.S. district judge has rejected arguments by the insurer Florida Blue that key quality ratings didn\u2019t 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 […]<\/p>\n","protected":false},"author":4,"featured_media":15251,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"rank_math_lock_modified_date":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[22],"tags":[],"class_list":{"0":"post-15250","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-wellness"},"jetpack_featured_media_url":"https:\/\/i3.wp.com\/www.sun-sentinel.com\/wp-content\/uploads\/2023\/04\/GCTCQCYSCBDLFDPF4BVXJAJR4Q-4.jpg?w=1400px&strip=all&w=1400&resize=1400,933&ssl=1","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/citystuff.com\/miami\/wp-json\/wp\/v2\/posts\/15250"}],"collection":[{"href":"https:\/\/citystuff.com\/miami\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/citystuff.com\/miami\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/citystuff.com\/miami\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/citystuff.com\/miami\/wp-json\/wp\/v2\/comments?post=15250"}],"version-history":[{"count":1,"href":"https:\/\/citystuff.com\/miami\/wp-json\/wp\/v2\/posts\/15250\/revisions"}],"predecessor-version":[{"id":15252,"href":"https:\/\/citystuff.com\/miami\/wp-json\/wp\/v2\/posts\/15250\/revisions\/15252"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/citystuff.com\/miami\/wp-json\/wp\/v2\/media\/15251"}],"wp:attachment":[{"href":"https:\/\/citystuff.com\/miami\/wp-json\/wp\/v2\/media?parent=15250"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/citystuff.com\/miami\/wp-json\/wp\/v2\/categories?post=15250"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/citystuff.com\/miami\/wp-json\/wp\/v2\/tags?post=15250"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}