The Trump administration is proposing significant changes to the metrics used to the calculate the Medicare Advantage star ratings.
As part of the Contract Year 2027 MA and Part D proposed rule, the Centers for Medicare & Medicaid Services has pitched that the Excellent Health Outcomes for All award, known previously as the Health Equity Index award, not be counted toward the 2027 star ratings calculations.
That award was designed to reward plans that earned high scores for the subset of beneficiaries with certain social risk factors. Instead, CMS is recommending that the program use the historical reward factor for these metrics, as it “encourages consistently high performance across all quality measures,” per a fact sheet.
CMS has also proposed removing 12 measures in 2027 as they focus on administrative processes and other areas where beneficiaries themselves often cannot see variation. The agency is also considering a new measure for Medicare Advantage plans for depression screening and follow-up that aims to close key gaps in behavioral healthcare.
That measure would be in place for the 2027 measurement year and later reflected in the 2029 star ratings scores.
“The Trump Administration is committed to ensuring Medicare beneficiaries have access to high-quality affordable care options,” said CMS Administrator Mehmet Oz, M.D., in a press release. “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.”
CMS said in the fact sheet that these changes are intended to “refocus the program on clinical care, outcomes, and patient experience where there is meaningful variation in performance across contracts” while also reducing the administrative work required for plans.
In addition, CMS has proposed a new special enrollment window that allows beneficiaries to switch plans if one or more of their regular providers goes out-of-network for their current plan. The proposal would nix the requirement that the MA organization and then CMS determine the network update to be “significant.”
The agency also said it is seeking feedback on the program from beneficiaries through a series of requests for information. The first focuses on risk adjustment and quality bonus payments in MA, with the goal of strengthening competition in the program.
The second RFI builds on recent enrollment growth in chronic condition special needs plans, or C-SNPs. CMS is looking for greater detail on why beneficiaries are choosing those plans instead of dual eligible special needs plans, or D-SNPs.
And finally, CMS is issuing an RFI seeking details on wellbeing and nutrition programs, and how the agency could do more to incentivize plans to focus on nutrition.
“The feedback will help guide the modernization of MA to ensure enhanced competition, improved health outcomes and better coordination of care for the nation’s most vulnerable Medicare beneficiaries,” CMS said in the fact sheet.
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