The Centers for Medicare and Medicaid Services (CMS) announced late Wednesday it is recalculating some Medicare Advantage (MA) contracts’ SY 2026 Star Ratings based on the “better of” the current 2026 ratings or the measures included in the recent Clover decision. A judge struck up to 20 measures.
CMS went out of its way to note that this does not set policy for SY 2027 ratings or beyond.
CMS said it recalculated using just HEDIS, CAHPS, and HOS measures. No Part D measures were included and the following were removed for Part C: SNP-CM, Complaints, Leave, the two Appeals measures, and Call Center. Based on the HPMS memo, in my view CMS does not appear to have followed the ruling exactly. I am waiting to see some plans’ recalculations to be sure. This could be related to measures that were clearly not covered by the statutes and those that were removed by the judge due to APA process issues. CMS both kept some measures called into question by the judge and removed one not squashed by the court.
Contracts that benefit from the recalculations are able to resubmit 2027 bids by the end of the month. While CMS characterized the Clover bid resubmission as an alternate bid, it is now characterizing the bid changes as resubmissions.
CMS was in a bit of a bind. In terms of equity, it could not have recalculated just Clover’s rating. It would have led to more lawsuits. But I do not believe CMS will give up the fight. It still could appeal. Further, I think CMS and Congress will get together to reinstate a robust Stars program.
#stars #quality #medicareadvantage #partd #pdp #cms
— Marc S. Ryan
