CMS Proposed Rule:

Star Ratings Changes Impacting Measurement Years 2026 & 2027

CMS proposes a major recalibration of the Medicare Advantage & Part D Star Ratings program for the 2026 - 2027 measurement cycle. The proposal aims to simplify the measure set, rebalance weighting toward clinical outcomes, delay implementation of the Health Equity Index (HEI) reward, and strengthen preview transparency. Plans should expect meaningful impacts on overall ratings, Quality Bonus Payments (QBPs), operational priorities, and internal resource allocation.

Key Proposed Changes Relevant to MY 2026–2027

1. Measure Set Streamlining (12 measures proposed for removal)

CMS proposes to remove several Part C and Part D measures - mostly process, administrative, and “topped-out” metrics, beginning with the 2028–2029 Star Year i.e. these changes indirectly affect strategy for MY 2026 & 2027 as plans prepare for retirements and display-page transitions.

Measures proposed for removal include:

• Plan Makes Timely Decisions About Appeals

• Reviewing Appeals Decisions

• SNP Care Management

• Call Center—Foreign Language Interpreter/TTY

• Complaints About the Health/Drug Plan

• MPF Price Accuracy

• Members Choosing to Leave the Plan

• Customer Service

• Rating of Health Care Quality

• Eye Exam (Diabetes)

• Statin Therapy for CVD (modified version moves to display before removal)

Implication: Shift focus toward clinical quality, pharmacy adherence, outcomes, and CAHPS/experience trends.

2. Depression Screening & Follow-Up (DSF) Advancement

• DSF will appear on the 2026 display page (data from MY 2024).

• CMS indicates potential for future inclusion in Star Ratings, likely tied to later cycles.

Implication: Plans must prepare workflows, documentation, HEDIS alignment, and follow-up reliability in MY 2026 & 2027.

3. Health Equity Index (HEI) Reward — Proposed Delay

CMS proposes not to implement the HEI reward for the 2027 Star Ratings and instead retain the historical reward factor.

Implication: Plans that prepared equity-focused scoring strategies must recalibrate expectations; equity efforts remain strategically important but may not yield near-term Star Rating point gains.

4. Measure Weighting Shifts

Proposed rebalancing reduces the weight of patient experience/complaints/access (e.g., CAHPS) from 4 → 2, emphasizing clinical outcomes.

Implication: Plans with strong CAHPS but weaker outcomes may see rating pressure; others may see gains.

5. Enhanced Plan Preview Transparency

CMS proposes codified requirements for more detailed data in the first and second preview cycles.

Implication: Plans must strengthen internal validation processes and modeling of QBP impacts during preview windows.

Bottom-Line Strategic Impact for Plans

• 2026 - 2027 Measurement Year work must shift toward outcomes, chronic condition control, pharmacy adherence, post-discharge care, and experience trends.

• CAHPS still matters but is less dominant than in 2021–2025 cycles.

• HEI delay lowers near-term risk; however, health equity infrastructure should continue as CMS is expected to revisit equity-focused scoring in future rulemaking.