Medicare Advantage Quality and Integration: Insights on CY 2027 Proposed Rule

The Medicare Advantage (MA) quality landscape is undergoing significant changes following the release of the Contract Year (CY) 2027 Proposed Rule by the Centers for Medicare and Medicaid Services (CMS). This proposal introduces major revisions to Star Ratings and the integration strategies for dual-eligible members, reflecting a push towards outcome-focused care and better alignment between Medicare and Medicaid programs. Although these policies await finalization, they indicate CMS's direction for the MA industry, emphasizing integrated and quality-driven care models for populations requiring both Medicare and Medicaid services. Health plans and state agencies are advised to monitor these developments closely to adapt to the evolving regulatory environment. The proposed changes underscore the increasing regulatory focus on effective integration of Long-Term Services and Supports (LTSS) and Dual-Eligible Special Needs Plans (D-SNPs), which are vital for enhancing care coordination and access for vulnerable beneficiaries.