Published in partnership with Lilac Software: https://lilacsoftware.com
Figuring out exactly what will happen in the Star measure program over time is no small feat. The Centers for Medicare and Medicaid Services (CMS) certainly does not make it easy to create a Stars roadmap so you are ready for a new measure maturing to Stars.
CMS will use a variety of means to telegraph what might occur. These include annual Medicare Advantage (MA) and Part D rules, the so-called Advanced and Final Notices/Announcement annually, and other CMS communications.
Even then, pulling it all together is tough. Things can change from proposed rules to finalized rules. CMS may give direction on a change in one year only to backtrack the next. You can never be 100% sure until the Advance Notice is finalized for the coming year. This usually drops in April of a given year. Sometimes, as they did with Star Year 2026 measures, CMS helps us out a bit and publishes a clear table of the Star measures and weights early.
The Star Year 2026 and beyond roadmap is very complex and there is uncertainty. There are new measures, returning measures, measures that will be removed from Star, weighting changes, conversions to electronic measures (ECDS), and some changes to how measures will be calculated.
Again, we do not know for sure in some cases when and if certain measures will make it to Star in a given year. But here is our take on what the MA Stars and Part D Roadmap look like right now. Some of this could change with the new administration. Will it finalize the proposed 2026 MA and Part D rule, which has major Star changes? Will it pull back on the Health Equity Index (HEI)? Will it move forward on streamlining measures by migrating more to the Universal Foundation? Time will tell.
So, even with some unknowns, our Stars Roadmap Table shows how we see the Star Roadmap rolling out. Below we highlight some key points of the Star Roadmap table.
SY 2026
- Colorectal cancer screening moves from a hybrid measure to an electronic (ECDS) measure. Breast cancer screening was the first to make the leap in Star Year 2025, but it was not a hybrid measure. Colorectal cancer screening thus is really the first one to jump. The fear is that the industry as a whole is ready and achievement could drop 5 to 10% overall across the industry. The existing guardrails will stop falls of cut points more than 5%, but this could unfairly hurt many plans due to artificially high Star thresholds. Many wonder why an ECDS conversion was deemed significant and why the measure was not moved to display for a few years.
- Patient Experience and Complaints and Access measures drop from 4x to 2x. Plans should compute the impact on their overall rating. The change moves the overall impact from survey and some operational measures to HEDIS clinical, PQA drug measures, and HOS. Depending on how contracts performed on the 4x measures will dictate if the change is beneficial, negative, or perhaps has little impact.
- HOS takes on additional prominence with the return of Improving/Maintaining Physical Health and Improving/Maintaining Mental Health.
- Given the importance of diabetes care, Kidney Health Evaluation for Persons with Diabetes is added.
- Another major change is the move from a member years calculation to a continuous enrollment concept for some of the PQA drug measures. This is consistent with PQA’s overall approach. This is not expected to have a significant impact. But plans should have noticed this change in calculations in Acumen patient safety reports.
SY 2027
- The HEI arrives to replace the Reward Factor and is based on MY 2024 and 2025. CMS has just released certain calculations of the HEI, including how the two measure years are blended and the most up-to-date thresholds for high (+1), middle (0), and low (-1) performance groupings. We do know that payouts in the aggregate related to the HEI are likely well below what the Reward Factor currently pays out.
- Improving/Maintaining Physical Health and Improving/Maintaining Mental Health jump to 3x weights.
- Three new or returning measures all at 1x weight:
- COA—Functional Status Assessment
- Concurrent Use of Opioids and Benzodiazepines
- Polypharmacy Use of Multiple Anticholinergic Medications in Older Adults
- The following three measures are being removed (some temporarily):
- Medication Reconciliation Post-Discharge
- COA Pain Assessment
- MTM CMR
- The colorectal cancer screening age range is being expanded down to age 45.
- A new statin tolerance exclusion is added to SUPD.
- The Hybrid chart review option is removed for Diabetes Eye Exam.
SY 2028
- The MA and Part D draft rule proposes to add Initiation and Engagement of Substance Use Disorder Treatment with a 1x weight.
- The MA and Part D draft rule proposes to add Initial Opioid Prescribing for Long Duration with a 1x weight.
- PQA and CMS will institute a risk-adjustment methodology and remove inpatient and skilled nursing facility adjustments for the medication adherence measures. These will be on the Display page with these changes and be introduced as a new Star as a 1x weight in SY 2028.
- CMS proposes to remove guardrails for non-CAHPS measures when calculating cut points. CMS’ proposed rule does not meet legal requirements and would likely be challenged in court. See the earlier blog on CMS’ proposed Star changes for 2026 for details.
- In the 2026 Advance Notice, CMS said it was looking at measure specification changes and conversion of Statin Therapy for CVD as of measurement year 2026. If that occurs, the measure would be moved to display as of Star Year 2028.
SY 2029 and Beyond
- Substantive changes are proposed for Plan Makes Timely Decisions about Appeals (Part C) and the Reviewing Appeals Decisions (Part C). CMS has proposed to make these changes effective for SY 2029. But CMS really cannot move to the changed measures until SY 2030 based on existing rules. Prior to this, the revamped measures will be on the Display Page.
- Substantive changes and an expanded age group are proposed for Breast Cancer Screening. The changes would be made for SY 2029 and the revised measure would be on the Display Page before then.
Future potential measure additions/changes
We are anticipating the possibility of some other measure additions and changes based on what CMS has said, but these are not yet firm. As noted, CMS wants to migrate more toward the Universal Foundation of measures across all quality programs. Thus, we could see the following come to Star soon.
- Social Needs Screening and Intervention (perhaps SY 2027)
- Depression Screening and Follow-Up for Adolescents and Adults (perhaps SY 2028)
- Adult Immunization (perhaps SY 2028)
- Physical Functioning Activities of Daily Living (perhaps SY 2029)
- Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults. (This was slated to move to Star but was pulled back due to technical issues. This could be reintroduced in the future.)
- CMS is entertaining the removal of the following. No dates are known at this time.
- MPF
- CTM (2)
- Call Center (2)
- Appeals (2)
- COA measures (3)
- MTM CMR
- SNP -CM
- Measure specification changes and conversions include the following. These are slated for no earlier than SY 2031.
- Conversion of Diabetes Blood Sugar to ECDS
- Conversion of Transitions of Care to ECDS
- Measure specification changes and ECDS conversion of COA-Functional Status and COA-Medication Review
- Adjusting HEDIS-HOS measures
- Adding a Geographic Factor (Urban/Rural indicator) to the Health Equity Index. CMS is soliciting input and the implementation year is unknown.
Lilac Software Star Measure Roadmap

Star measures for Medicare Advantage plans get updated every year. The types of changes include changes to the weights of existing measures, new measure specifications, retirement of measures, and introduction of new measures. Lilac’s experts closely monitor all of CMS’ many communication channels to track all confirmed and possible changes. Our current assessment of upcoming changes is reflected in the table below.
Star Year 2026 | Star Year 2027 | Star Year 2028 | Star Year 2029 | Other Changes Mentioned |
Colorectal Cancer Screening becomes ECDS. | Health Equity Index replaces the Reward Factor (Measure Years 2024 and 2025). | New Measure Initiation and Engagement of Substance Use Disorder Treatment (1x) (if 2026 MA and Part D rule finalized) | Substantive changes to Plan Makes Timely Decisions about Appeals (Part C) and the Reviewing Appeals Decisions (Part C) – SY 2029 or SY 2030. | Additional Universal Foundation measure adoption TBD: – Social Need Screening and Intervention (possible SY 2027) – Depression Screening and Follow-Up (possible SY 2028) – Adult Immunization at 1x weights (possible SY 2028) – — Physical Functioning Activities of Daily Living (possible SY 2029) |
Patient Experience and Complaints and Access measures drop from 4x to 2x. | Improving/Maintaining Physical Health and Improving/Maintaining Mental Health move to 3x weights. | New Measure Initial Opioid Prescribing for Long Duration (1x) (if 2026 MY and Part D rule finalized) | Substantive changes/expanded age group for Breast Cancer Screening – SY 2029. | Polypharmacy: Use of Multiple Anticholinergic Medications in Older Adults (possible – year to be determined) |
Returned Measures Improving/Maintaining Physical Health and Improving/Maintaining Mental Health (1 weight each). | Returned Measure Updated COA —Functional Status Assessment (1x weight). | Risk-adjustment methodology and removal of IP/SNF adjustments for medication adherence measures (Drop to 1x weights for 1 year). | Add Geography to Health Equity Index – urban/rural indicator (possible – year to be determined) | |
New Measure Kidney Health Evaluation for Persons with Diabetes (1x weight). | New Measures Concurrent Use of Opioids and Benzodiazepines (COB) and Polypharmacy Use of Multiple Anticholinergic Medications in Older Adults (Poly-ACH) (1x weights each). COB also excludes cancer pain treatment for COB (non-substantive change). | Remove guardrails for non-CAHPS measures when calculating cut points (possible). | Removal of following (possible – year to be determined): – MPF – CTM (2) — Call Center (2) – Appeals (2) – COA (3) – MTM CMR – SNP -CM | |
Continuous enrollment and other calculation changes to be consistent with PQA for Medication Adherence measures and SUPD measure. | Removal of (1) Medication Reconciliation Post-Discharge, (2) COA Pain Assessment, and (3) MTM CMR. | Removal of Statin Therapy for CVD (possible – if measure specifications change and conversion to ECDS) | Conversion of Diabetes Blood Sugar to ECDS (possible SY 2031) | |
Colorectal cancer screening age range expanded. | Conversion of Transitions of Care to ECDS (possible SY 2031) | |||
Statin tolerance exclusion for SUPD. | Measure specification changes and ECDS conversion of COA-Functional Status and COA-Medication Review (possible SY 2031) | |||
Diabetes Care — Eye Exam – removal of chart review option. | Adjust HEDIS-HOS measures (possible SY 2031) |
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— Marc S. Ryan