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The Centers for Medicare and Medicaid Services is proposing enhancements to the Medicare Advantage and Part D Star Ratings program.
Beginning in the 2027 measurement year, CMS proposes to remove measures focused on administrative processes or that do not convey variability in quality among plans.
CMS seeks public input through a new request for information (RFI).
WHY THIS MATTERS
The rule proposes the removal of 12 unique measures to create a more focused MA star ratings system, CMS said.
This will allow plans to focus on the core purpose of measuring and incentivizing quality improvements while reducing unnecessary administrative burden.
The changes retain many measures focused on clinical care, outcomes and patient experience.
CMS said it is proposing not to move forward with implementing the Excellent Health Outcomes for All reward (previously called the Health Equity Index reward) and to continue to include the historical reward factor that incentivizes high and stable relative performance across measures.
CMS also proposes to introduce a new Depression Screening and Follow-Up measure that would begin with the 2029 star ratings to address critical mental health needs among beneficiaries.
These changes will “rebalance” the inventory of measures to focus more on health outcomes and preventive care, CMS said.
The rule also proposes to offer a new special enrollment period (SEP) for provider terminations and codify long-standing policy regarding utilization of SEPs. CMS gave no further immediate information on the SEP.
THE LARGER TREND
Thirty-four Medicare Advantage plans earned 5 stars in the MA Part C and D star ratings for 2026 released by the Centers for Medicare and Medicaid Services in October.
This compares to only seven plans that received the highest rating for the 2025 plan year and 38 contracts that received 5 stars for 2024.
Email the writer: SMorse@himss.org