Each year, the release of the Centers for Medicare & Medicaid Services (CMS) Final Rule marks a pivotal moment for Medicare Advantage (MA) and Part D plans. While the Advance Notice offers an early look at potential changes, the Final Rule confirms which measure updates and policy decisions will move forward, setting the regulatory framework health plans must now operate within. For the 2027 Star Ratings year and beyond, these final decisions carry meaningful implications for quality strategy, performance focus, and financial outcomes.
Here are three important changes quality leaders should keep in mind:
- Health Equity Index: CMS finalized its decision not to implement the Excellent Health Outcomes for All reward (formerly the Health Equity Index) and will instead continue using the historical reward factor that incentivizes consistent performance across all quality measures and enrollee populations.
- Streamlining measures: 13 Star Ratings measures focused on administrative processes or areas with little performance variation will be removed. However, CMS retained the Diabetes Care–Eye Exam measure after stakeholder feedback.
- Behavioral health: CMS finalized the addition of a new Depression Screening and Follow‑up Measure, starting with the 2027 measurement year and contributing to 2029 Star Ratings.
Learn more in our live webinar
While it’s often difficult to grasp the full scope of these changes and what to prioritize next, MA quality teams don’t have to do it alone. I invite you to join me and my colleague Dani Sutherland, senior Stars analyst, as we break down the implications of the Final Rule and offer MA plans a framework for success in the months to come.
Don’t miss the third webinar in our 2026 Quality Decoded series on Thursday, April 23, at 1 pm ET as we offer clarity for MA quality leaders amid ongoing regulatory change.
For those interested in the risk adjustment perspective on the Final Rule and Rate Notice, Cotiviti’s Risk Adjustment Essentials webinar series will offer complementary insights in our next live webinar on Tuesday, April 28.
Don’t miss this opportunity to stay on top of the CMS Final Rule and take advantage of new avenues to improve care quality throughout 2026 and the years to come. We look forward to seeing you there.
