The Centers for Medicare & Medicaid Services (CMS) is "removing 11 measures focused on administrative processes" from the Medicare Advantage (MA) and Part D Star Ratings, finalized in the contract year 2027 final rule released April 2, 2026. CMS describes the goal as refocusing the program "on clinical care, outcomes, and patient experience where meaningful performance differences exist across contracts."
The 219-page rule was published in the Federal Register on April 6 at 91 FR 17384. CMS estimated the net impact at $18.56 billion on the Medicare Trust Fund from 2027 through 2036, or 0.21 percent of Medicare payments to MA plans, driven largely by increased bonus payments. Published analyses of the rule put roughly 63 percent of contracts at no change to their overall rating.
Nothing in this rule touches the 2027 Star Ratings measure set. Despite the CY2027 label, the earliest measure impact arrives with the 2028 Star Ratings. The bulk lands in 2029. The only 2027 Star Ratings item is the decision on the equity reward, covered below. Quality teams building a 2027 improvement plan are working with the measure set they already have.
The timing, by measurement year
Measurement year 2026, feeding the 2028 Star Ratings. Three measure removals take effect: Call Center Foreign Language Interpreter and TTY Availability, both Part C and Part D, and Statin Therapy for Patients with Cardiovascular Disease, Part C.
Measurement year 2027, feeding the 2029 Star Ratings. The remaining removals take effect, covering appeals timeliness and appeals review, Special Needs Plan Care Management, Complaints about the Health or Drug Plan, Members Choosing to Leave the Plan, and Medicare Plan Finder Price Accuracy. Published analyses of the final rule also place two Part C CAHPS measures, Customer Service and Rating of Health Care Quality, in this group.
The same measurement year brings the one addition. CMS is "adding a new Part C Depression Screening and Follow-Up measure to address behavioral health gaps starting with the 2027 measurement year and 2029 Star Ratings." Plans building depression screening workflows have measurement year 2026 to test them before the results start counting.
CMS also declined one proposed removal. The proposed rule listed 12 measures. The final rule lists 11, and the press release explains why: "Based on stakeholder feedback, CMS is retaining the Diabetes Care Eye Exam measure in the Part C Star Ratings, recognizing its importance in preventing serious complications."
The equity reward is off the table
CMS "is not implementing the Excellent Health Outcomes for All reward (previously called the Health Equity Index reward)" and will "continue the historical reward factor that encourages consistently high performance for all enrollees." EHO4All was scheduled to replace the historical reward factor beginning with the 2027 Star Ratings. The replacement is cancelled, and the reward factor plans have modeled against for years stays in place.
What shifts underneath the rating
Three things move, and none of them are measure removals.
Weights did not change in this rule, and the ones people ask about changed earlier. The reduction of patient experience, complaints, and access measures from a weight of 4 to a weight of 2 was finalized in the CY2025 final rule and took effect with the 2026 Star Ratings. The current categories stand: improvement measures at 5, outcome and intermediate outcome measures at 3, experience and access measures at 2, process measures at 1. What the CY2027 rule does to CAHPS is subtract measures from it, not reweight it.
The improvement measures get more leveraged. Health Plan Quality Improvement and Drug Plan Quality Improvement survive at a weight of 5. Remove 13 measure identifiers from the denominator and those two weight-5 measures represent a larger share of the total. One published distribution of the 2029 Star Ratings weighted set puts improvement at 16 percent, HEDIS® at 28 percent, CAHPS at 21 percent, pharmacy at 20 percent, HOS at 15 percent, and administrative measures at zero.
Medication adherence takes a two-year detour. The three Part D adherence measures, diabetes, hypertension, and cholesterol, pick up sociodemographic status risk adjustment beginning with measurement year 2026. Substantively updated measures drop to a weight of 1 in their first year, so consultant analyses put adherence at a weight of 1 for the 2028 Star Ratings before returning to 3 for 2029. Pharmacy leadership planning a three-year Stars roadmap will want the dip modeled rather than discovered.
Cut points did not change, and the reason matters
CMS finalized no cut-point methodology changes. Tukey outer fence outlier deletion, mean resampling with hierarchical clustering, and the five-percentage-point guardrail all stand as they are. Section V.C of the rule invited comment on streamlining the methodology without finalizing anything, which signals future rulemaking rather than current change.
Two exceptions to the guardrail deserve attention. Guardrails do not apply to new or substantively updated measures in their first year, and they do not apply to the weight-5 improvement measures. Every measure entering or re-entering the set arrives without a cut-point ceiling, and Depression Screening and Follow-Up enters the 2029 Star Ratings in exactly that position.
What this means for health plans
A smaller measure set concentrates risk. When 43 measures carry a rating, one weak performer gets diluted. When the set shrinks and administrative measures come out, the clinical, pharmacy, and experience measures left standing absorb the difference, and a single weight-3 outcome measure moving half a star matters more than it used to.
The administrative measures coming out were, for many plans, reliable points. Call center metrics and appeals timeliness respond to operational discipline in ways clinical outcomes do not. Losing them removes a floor as well as a burden.
The encouraging read is on timing. The first removals land with measurement year 2026, already underway, and the substantial changes arrive with measurement year 2027, which has not started. Plans have a full planning cycle to remodel their weighted portfolio, identify where marginal effort still buys rating movement, and reallocate. Enrollment-weighted average MA-PD ratings have drifted down over the past three years, from 4.14 in 2023 to 3.98 in 2026 by one published count, and the plans regaining ground are the ones treating the measure set as a portfolio rather than a checklist.
Questions to consider
- Have you recalculated your weighted measure portfolio under the 2029 Star Ratings set, and which two or three measures now carry disproportionate leverage?
- What share of your current rating comes from measures being removed, and where does the weight land instead?
- Is the medication adherence weight dip in the 2028 Star Ratings reflected in your pharmacy roadmap and your PBM conversations?
- Do you have a baseline for Depression Screening and Follow-Up, and does measurement year 2026 give you time to build one?
- Which measures respond to marginal investment at your current performance level, and where has additional spend stopped buying rating movement?
RISE will recalculate the weighted portfolio, model cut-point movement under the leaner set, and stress-test paths to the next threshold in the Stars Reshuffled panel at The 16th Annual HEDIS® & Quality Improvement Summit, November 3-5, in Baltimore. And don't miss a deep dive into all things Stars at The RISE Star Ratings Master Class, December 14-16 in Scottsdale.