The Centers for Medicare & Medicaid Services (CMS) has announced proposed updates to the Medicare Advantage (MA) and Medicare Part D prescription drug programs. These changes aim to enhance quality, improve access to care, and encourage innovation in benefit design. The Contract Year 2027 MA and Part D proposed rule includes significant revisions to the Star Ratings system and seeks public input on modernizing MA.
"The Trump Administration is committed to ensuring Medicare beneficiaries have access to high-quality affordable care options," said CMS Administrator Dr. Mehmet Oz. "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."
Each year, CMS publishes MA and Part D Star Ratings on the Medicare Plan Finder website and CMS.gov. These ratings assess the quality of health and drug services provided by MA plans and Prescription Drug Plans (Part D plans). The proposed rule suggests enhancements to these ratings, encouraging plans to improve care for enrollees.
Starting in the 2027 measurement year, CMS proposes streamlining Star Ratings by removing measures focused on administrative processes or those not reflecting variability in plan quality. The current methodology recognizing consistently high-quality care will be maintained, with potential simplifications considered for the future.
The proposal includes not implementing the Excellent Health Outcomes for All reward but continuing with a historical reward factor incentivizing stable performance across measures. Twelve unique measures would be removed from the Star Ratings system, focusing more on clinical care, outcomes, and patient experience.
A new Depression Screening and Follow-Up measure is proposed for introduction with the 2029 Star Ratings to address mental health needs among beneficiaries. This aims to shift focus towards health outcomes and preventive care.
Additionally, a new special enrollment period (SEP) for provider terminations is proposed alongside codifying existing SEP policies. Public feedback is invited through a Request for Information (RFI) examining options for improving competition, refining risk adjustment, and aligning quality incentives.
The public can comment on this proposal within 60 days following its publication in the Federal Register: https://www.federalregister.gov/public-inspection/current. More details are available in the fact sheet at: https://www.cms.gov/newsroom/fact-sheets/contract-year-2027-medicare-advantage-part-d-proposed-rule.
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