The proposed updates include changes to Star ratings measures that the Centers for Medicare & Medicaid Services (CMS) believe will incentivize Medicare Advantage (MA) and Part D plans to focus more on health outcomes and preventive care.
CMS on Tuesday released proposed new policies for MA and Medicare Part D prescription drug programs for calendar year 2027.
The 465-page proposed rule, which is scheduled to be published in the Federal Register on November 28, includes major changes to Star ratings quality measures. The agency uses the measures to rank Medicare Advantage and drug plans. High performing plans qualify for coveted quality bonus payments and may use the additional payments to cover the cost of supplemental benefits, reduce cost sharing, or provide extra benefits not covered by traditional Medicare.
Comments are due by January 26, 2026.
Among the proposed changes announced in the rule, CMS said it wants to:
- Streamline Star ratings by removing measures focused on administrative processes or that do not convey variability in quality among plans. Although the agency plans to maintain the current Star ratings methodology, CMS said it is also considering ways to simplify the methodology in the future.
- Not move forward with the Excellent Health Outcomes for All reward, which previously was known as the Health Equity Index reward, and was designed to reward high measure-level scores for a subset of enrollees with specified social risk factors. Instead, CMS intends to continue to include the historical reward factor that provides incentives for high and stable relative performance across measures.
- Remove 12 measures to create a more focused Star ratings system that will measure and incentive quality improvements that directly benefit MA and Part D members, while reducing unnecessary administrative burdens on plans.
- Retain measures that focus on clinical care, outcomes, and patient experience.
- Introduce a new Depression Screening and Follow-Up measure beginning with the 2029 Star ratings to address critical mental health needs among beneficiaries.
- Offer a new special enrollment period (SEP) for provider terminations and codify long-standing policy regarding utilization of SEPs.
- Seek public feedback through a Request for Information (RFI) on how to modernize MA, examining options for improving competition, refining risk adjustment, and aligning quality incentives to deliver greater value to members. The RFI seeks input on how CMS could achieve these efforts through either a time-limited model test under the CMS Innovation Center’s authority or potential program-wide regulatory changes.
In a fact sheet, CMS said the proposed changes aim to refocus the program on clinical care, outcomes, and patient experience, while reducing administrative burden on plans by removing operational and process measures that have achieved high performance with little variability, allowing plans to concentrate resources on areas that directly impact patient care and health outcomes.
“The Trump Administration is committed to ensuring Medicare beneficiaries have access to high-quality affordable care options,” said CMS Administrator Dr. Mehmet Oz in the announcement “This proposed rule continues that commitment by enhancing Star Ratings to reward meaningful improvements in quality and innovation, while making it easier for beneficiaries to compare and choose coverage that best meets their needs.”
RISE will take a deeper look at the proposed changes in the upcoming weeks, as well as the RISE Star Ratings Master Class in Dallas in December, and RISE National 2026 in Orlando in March 2026.