CMS Proposes Medicare Advantage Star Ratings Changes for 2027

The Centers for Medicare & Medicaid Services (CMS) has proposed revisions to the Medicare Advantage (MA) star ratings framework as part of the Contract Year 2027 MA and Part D proposed rule. A primary change includes excluding the Excellent Health Outcomes for All award, formerly the Health Equity Index award, from the star ratings calculation. CMS argues that reverting to the historical reward factor promotes consistent performance across all quality measures. Additionally, CMS is proposing the removal of 12 measures that focus on administrative processes with limited beneficiary visibility, aiming to streamline the evaluation criteria. A new measure for depression screening and follow-up is also under consideration, targeting gaps in behavioral health care, with implementation planned for the 2027 measurement year and influence on 2029 star ratings. CMS emphasizes these changes will refocus the star ratings program on clinical care, health outcomes, and patient experience areas showing meaningful performance variation. Furthermore, the agency intends to reduce administrative burdens on plans, enhancing both efficiency and beneficiary clarity in plan comparisons. The proposed rule also introduces a special enrollment window allowing beneficiaries to switch plans if their regular providers leave the network, simplifying network change procedures by removing the "significant" network update requirement. CMS is actively seeking stakeholder input through multiple Requests for Information (RFIs), covering topics such as risk adjustment, quality bonus payments, growth patterns in chronic condition special needs plans (C-SNPs), and opportunities to incentivize nutrition and wellbeing programs within Medicare Advantage. These initiatives aim to modernize Medicare Advantage by promoting market competition, improving health outcomes, and enhancing care coordination for vulnerable Medicare beneficiaries.