CMS & CMMI Updates

MA Star Ratings

Part C & Part D Star Ratings — Comprehensive Historical Reference, 2007–2027

Source: CMS Part C & D Star Ratings Technical Notes & Performance Data • Values Edge, LLC

Star Ratings Lifecycle & Timing

The Star Ratings program spans ~3 years from performance measurement through revenue impact. The Advance Notice and Final Rule occur the year after data collection, when CMS proposes how that performance data will be scored. The chart below uses the 2024–2026 cycle as a concrete example.

2024 — Performance Year
2025 — Methodology & Rating
2026 — Revenue Impact
J
F
M
A
M
J
J
A
S
O
N
D
J
F
M
A
M
J
J
A
S
O
N
D
J
F
M
A
M
J
J
A
S
O
N
D
Performance Year
Jan – Dec 2024
Advance Notice
Feb
Final Rule
Apr
CMS User Call
Aug
Ratings Released
Oct
QBP Revenue Impact
Jan 2026 → ongoing

Performance Year (2024)

Full-year data collection across HEDIS clinical measures, CAHPS member surveys (spring), HOS outcomes, and CMS administrative claims. This is the year plans are actually measured on quality.

Advance Notice (Feb 2025)

CMS publishes proposed methodology for scoring the 2024 performance data. First signal of weight changes, measure additions/retirements, and cut point methodology for the upcoming Star Ratings.

Final Rule (Apr 2025)

Confirmed methodology becomes official. Weight changes, new measures, and retirements are locked in. Plans learn exactly how their 2024 performance data will be scored.

CMS User Call (Aug 2025)

Technical briefing where CMS presents implementation details, cut point results, and answers plan questions. Key intelligence event for quality and strategy teams.

Ratings Released (Oct 2025)

Star Ratings published on Medicare Plan Finder. Plans learn their ratings and QBP eligibility. Consumers see ratings during Open Enrollment (Oct 15 – Dec 7).

QBP Revenue (Jan 2026+)

Quality Bonus Payments flow based on published ratings. 4+ star plans receive 5% benchmark increase (10% in double-bonus urban counties). Revenue impact continues for 12+ months.

The 2-Year Lag

Performance measured in 2024 determines Star Ratings released in October 2025, which drive Quality Bonus Payments starting January 2026. This means today's operational decisions won't affect revenue for ~2 years. Plans must invest in quality improvement well ahead of when the financial impact materializes.

Note: NCQA HEDIS specification changes can shift measure definitions mid-cycle, meaning the goalposts can move even after a performance year begins.

21
Program Years
2007–2027
42
Total Measures
2027 program year
$15B+
QBP Revenue
Annual impact
6
Weight Categories
Improvement highest

Program Timeline

2027
Reward Factor eliminated, replaced by Health Equity Index (HEI). MTM Completion Rate retired. Two new opioid/polypharmacy measures. Functional Status returns from display. CMS signals equity-first future.
2026
MAJOR: CAHPS/Access weights drop 4→2. Physical & Mental Health measures return at weight 1 (new). Two new diabetes measures. Largest structural weight shift since 2012.
2025
Readmissions weight increases 1→3. Minor changes. Average MA-PD overall: ~4.17 stars.
2024
Tukey outlier deletion implemented. Cut points shift upward — makes 4+ stars significantly harder. SCAN Health Plan and Elevance Health file lawsuits challenging Tukey methodology. Readmissions weight reset to 1 (new specs).
2023
Rheumatoid Arthritis Management retired. Adult BMI Assessment retired. Health equity stratified reporting begins (not yet scored).
2022
Major methodology overhaul: "Better of" methodology, mean resampling in clustering, guardrails (5pp max cut-point change). HOS Physical/Mental Health removed from scoring.
2020-21
COVID-19 disruption. CMS carries forward 2019 CAHPS data. In-person HEDIS collection suspended. Special scoring rules applied. HOS Physical/Mental Health measures suspended.
2019
Medication Reconciliation Post-Discharge added. Relatively stable year.

Measure Count Over Time

YearPart CPart DSharedTotal
20273213342
20263312342
2024-253012339-42
2022-2330-3114-15342-43
2019-213214343-46
2016-1832-3414-15344-47
2011-15~32-33~14-153~44-47
2009-10~28-30~143~40-42
2008~20~18~3~35
20070 (Part D only)~180~18

Data Sources

HEDIS

Healthcare Effectiveness Data & Information Set. Clinical quality measures defined by NCQA.

Collection: Plans submit data annually; NCQA audits.

Measures: Screenings, chronic disease mgmt, medication, follow-up measures

CAHPS

Consumer Assessment of Healthcare Providers & Systems. Member satisfaction surveys.

Collection: CMS-contracted vendors survey members Mar–May yearly.

Measures: Patient experience, access, customer service, plan ratings

CMS Admin

Claims, enrollment, complaints (CTM), appeals, disenrollment data.

Collection: Continuous collection from CMS systems.

Measures: Appeals timeliness, complaint rates, member retention, access

HOS

Health Outcomes Survey. Longitudinal survey of physical/mental health status.

Collection: Baseline at enrollment, follow-up 2 years later.

Measures: Improving/Maintaining Physical Health, Mental Health

PDE / IRE

Prescription Drug Event data and Independent Review Entity data.

Collection: Drug claims records + appeals data.

Measures: Medication adherence, drug pricing, drug safety

PQA

Pharmacy Quality Alliance. Drug safety and adherence measure specifications.

Collection: Calculated from PDE data using PQA specifications.

Measures: Adherence (diabetes, hypertension, cholesterol), statin use, high-risk meds