Natural disasters like hurricanes, wildfires, floods, and other emergencies don’t just damage buildings or displace communities, they also disrupt the operations of health plans. When these events hit, everything from patient access to customer service can suffer. And when that happens, CMS Star Ratings can take a hit too.
This article explains how disasters can affect Medicare plan performance, what CMS does to adjust ratings during emergencies, and what health plans can do to protect their scores during and after a crisis.
What Are CMS Star Ratings?
CMS Star Ratings measure the performance of Medicare Advantage and Part D plans. These ratings are updated yearly and range from 1 to 5 stars, with 5 being the best. They help beneficiaries compare plans and also affect payments and bonuses from CMS.
Ratings are based on over 40 performance measures, grouped into categories like:
- Member experience and satisfaction
- Managing chronic conditions
- Customer service
- Access to care
- Patient safety and medication adherence
Any disruption in these areas, like delayed medications or missed check-ups, can pull down scores.
How Do Disasters Disrupt Plan Performance?
During an emergency, plans face serious challenges:
- Pharmacies may close, causing delays in prescription refills.
- Clinics may cancel appointments, affecting chronic care follow-ups.
- Call centers may go down, reducing access to customer support.
- Mail may be delayed, affecting member outreach and surveys.
- Data tracking can break down, impacting measure reporting.
Each of these disruptions has a direct or indirect effect on Star Rating measures. For example, missed appointments can reduce a plan’s chronic condition management score. Poor customer service during a crisis can affect CAHPS scores (member satisfaction). Even a week of disruption can impact annual reporting if not handled carefully.
How CMS Adjusts Ratings During Declared Disasters
CMS understands that disasters can create problems beyond a plan’s control. That’s why it has a policy called the “Extreme and Uncontrollable Circumstances Policy.” When FEMA declares a disaster in a specific area, CMS may apply this policy to health plans operating in those zip codes.
This means:
- Affected plans may get measure exclusions (some quality measures are removed from scoring).
- Some Star Ratings may be carried over from the previous year to prevent unfair penalties.
- CMS may suppress certain data (e.g., poor CAHPS results from disaster zones).
However, this doesn’t happen automatically. Plans must show that their performance was directly affected by the disaster. Documentation is key.
What Contingency Plans Should Include
To protect Star Ratings during emergencies, health plans must act fast, and have a clear response plan ready. Here’s what a strong contingency plan should cover:
1. Emergency Contact Lists
Have updated contact lists for:
- Local clinics and pharmacy partners
- Plan staff and leadership
- Backup service vendors
- FEMA/local disaster support centers
Quick communication helps speed up support services and minimize delays.
2. Backup Communication Channels
Make sure your plan has:
- Alternate call center support (off-site or remote staff)
- Text message or email systems to reach members
- Pre-approved messages for disaster outreach
Members need quick, clear updates about how to get care, refills, or support during a crisis.
3. Emergency Medication Access Policies
Many disruptions involve medication delays. Your plan should:
- Allow early refills or overrides
- Waive prior authorization during declared emergencies
- Partner with national pharmacy chains for out-of-area support
This helps maintain medication adherence scores, which are heavily weighted in Star Ratings.
4. Claims and Data Tracking Adjustments
Plans should flag affected claims or service gaps in their system. Documenting which services were disrupted (and when) can help when applying for measure exclusions from CMS later.
Also, maintain an internal log of disaster-related complaints, call volume spikes, or system failures.
5. Clear Member Outreach Scripts
Front-line teams should have prepared scripts for:
- Answering member questions about benefits or care access
- Explaining early refill options
- Guiding members to disaster relief services
- Calming frustrated members who can’t access care
This helps reduce member dissatisfaction, which can hurt survey scores.
6. Plan for Catch-Up Care
Once the crisis passes, plans should:
- Reach out to high-risk patients for checkups
- Reschedule missed preventive care (like flu shots or screenings)
- Run reports to identify dropped care gaps
- Offer telehealth when in-person visits are hard
These actions not only help restore care quality, they also boost performance measure recovery.
Common Disasters That Affect Ratings
CMS has reviewed performance adjustments for events such as:
- Hurricanes (e.g., Harvey, Irma, Maria)
- Wildfires in California
- Floods in the Midwest
- Severe winter storms
- Pandemics, like COVID-19
Each of these events created large-scale disruptions. Plans in affected areas that responded quickly, by reaching out to members and keeping service gaps small, saw better outcomes in the following year.
What If Your Plan Is Outside the FEMA Zone?
Sometimes parts of a service area are affected by a disaster, but FEMA doesn’t officially declare the entire zone. In these cases:
- Document all member impact and service issues
- Submit your case directly to CMS for measure adjustment consideration
- Ask provider partners to support your documentation
Even partial relief from CMS can help preserve your overall score.
The Long-Term View: Reputation and Renewal
Star Ratings affect more than just bonuses, they also influence member trust and plan enrollment. After a disaster, plans that communicate clearly and support members tend to retain loyalty.
Actions taken in a crisis, like helping a member get a lifesaving medication or answering a worried call quickly, create real-world goodwill. That goodwill often turns into better CAHPS scores and renewals.
Quick Summary: Key Actions to Protect Your Ratings
| Action | Why It Matters |
| Pre-plan alternate access to meds | Supports adherence and safety measures |
| Set up disaster-specific call scripts | Keeps CAHPS scores from dropping |
| Document service gaps carefully | Helps qualify for CMS measure suppression |
| Communicate often with members | Reduces dissatisfaction and missed care |
| Resume care quickly post-crisis | Helps recover performance metrics before reporting |
Conclusion
Disasters test more than just emergency plans, they test leadership, systems, and how well a health plan protects its members under pressure. A plan that prepares thoughtfully, responds quickly, and documents everything is not only protecting its Star Ratings, it’s doing right by its members.
Whether it’s a storm, fire, or any large-scale disruption, health plans that make disaster recovery part of their quality strategy are better positioned to serve, recover, and thrive.
