CMS Announces Reforms to Improve Medicare Star Ratings

On November 25, the Centers for Medicare & Medicaid Services (CMS) announced proposed updates to the Medicare Advantage (MA) and Medicare Part D prescription drug programs. According to a press release, the Contract Year (CY) 2027 MA and Part D proposed rule includes key improvements to the Star Ratings system and invites public input on new ways to modernize MA to better serve beneficiaries and taxpayers.  

In the proposed rule, CMS suggests improvements to the MA and Part D Star Ratings that would motivate MA and Part D plans to enhance enrollee care. Starting in 2027, CMS plans to simplify the Star Ratings by removing measures focused on administrative processes or those that do not reflect differences in quality among plans.

According to the press release, CMS is also proposing to retain the current Star Ratings methodology, which recognizes consistently high-quality care, while exploring ways to simplify it in the future. CMS recommends not moving forward with implementing the Excellent Health Outcomes for All reward (formerly called the Health Equity Index reward) and suggests continuing to include the historical reward factor that encourages high and stable performance across measures. 

The rule recommends removing 12 specific measures to simplify the Star Ratings system. According to CMS, these changes keep many measures focused on clinical care, outcomes, and patient experience. CMS also proposes adding a new Depression Screening and Follow-Up measure that would start with the 2029 Star Ratings to address mental health needs among beneficiaries. 

Furthermore, the rule proposes offering a new special enrollment period (SEP) for provider terminations and codifying long-standing policy regarding the utilization of SEPs.

CMS is inviting public feedback through a new Request for Information (RFI) on modernizing MA. The proposed rule will be open for public comment for 60 days after publication in the Federal Register.