CMS Introduces Proposed Rule to Elevate Quality and Access in Medicare Advantage and Part D | iPharmaCenter

The Centers for Medicare & Medicaid Services (CMS) has proposed new policies for Medicare Advantage (MA) and Medicare Part D plans, aiming to improve quality, boost access, and support innovative benefit designs. The 2027 draft rule details significant changes to the Star Ratings system and invites public comments on how to further modernize Medicare Advantage for both beneficiaries and taxpayers.

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Under these proposed updates, CMS seeks to refine the Star Ratings methodology used to assess MA and Part D plans, prioritizing metrics that incentivize better care and outcomes for members. Specifically, 12 measures will be removed, focusing the system more directly on clinical care, patient experience, and outcomes, while minimizing ratings based on administrative tasks. CMS will retain the current performance reward methodology and has decided not to implement the previously proposed Health Equity Index reward.

A new addition is the Depression Screening and Follow-Up measure, set to be included in the Star Ratings from 2029, which addresses pressing mental health needs among Medicare beneficiaries. Alongside these changes, CMS is also proposing a new special enrollment period (SEP) for cases involving provider network changes and will codify previously established SEP policies.

CMS is asking for public feedback through a Request for Information (RFI) to guide future modernization efforts. This outreach focuses on strengthening competition, refining risk adjustment, and better aligning quality incentives across plans. Such input could inform either targeted program model testing or wider regulatory reforms.

Overall, these updates represent a concerted effort by CMS to enhance quality measurement, reduce administrative burden, and ensure that Medicare Advantage and Part D continue to deliver greater value and adapt to evolving healthcare needs.