2026 CMS Final Rule: 4 Recommendations
- Medicare Advantage (MA) plans are navigating a shifting regulatory landscape as the Centers for Medicare & Medicaid Services (CMS) refines its Star Ratings program.
- For the 2029 Star Ratings, based on Measurement Year 2027, the most notable change is the expanded age range for breast cancer screening, now covering women ages 40-74,...
- CMS is renaming the health Equity Index reward to Excellent Health Outcomes for All (EHO4all).
medicare advantage plans must adapt to the latest shifts in the CMS Star Ratings. This is the chief takeaway from the 2026 CMS Final Rule, and it demands immediate attention. The rule introduces key updates,including expanded breast cancer screening eligibility and a renaming of the Health Equity Index to Excellent Health Outcomes for All (EHO4all). Health plans must prepare for more frequent use of interim and direct final rules,necessitating agile responses. To thrive, plans should embrace holistic member care and data-driven decisions. News Directory 3 understands these changes and their implications. Proactive strategies, including digital change and strong provider relationships, are vital. discover what’s next in the dynamic landscape of Medicare Advantage.
Medicare Advantage Plans Adapt to CMS Star Ratings Changes
Updated may 31,2025
Medicare Advantage (MA) plans are navigating a shifting regulatory landscape as the Centers for Medicare & Medicaid Services (CMS) refines its Star Ratings program. The 2026 Final Rule and Rate Announcement, released in April, reveal key updates and future directions for MA plans.While some proposed changes were deferred, the final rule offers insights into CMSS priorities and how plans can adapt to maintain high ratings.
For the 2029 Star Ratings, based on Measurement Year 2027, the most notable change is the expanded age range for breast cancer screening, now covering women ages 40-74, up from 50-74. This updated measure will be displayed for two years before impacting Star Ratings.
CMS is renaming the health Equity Index reward to Excellent Health Outcomes for All (EHO4all). This initiative focuses on improving care for enrollees dually eligible for Medicaid,those receiving low-income subsidies,or those with disabilities. These groups are prioritized due to data showing gaps in their care quality.
CMS is considering geography as a factor in the EHO4all award, but further changes would require additional rulemaking.
To implement changes, CMS uses several methods, including the traditional “propose and comment” process, interim final rules for urgent situations, and direct final rules for noncontroversial updates. Given the current emphasis on rapid rulemaking, MA plans should anticipate more interim and direct final rules.
To navigate these changes, MA plans should adopt a holistic approach to member care, considering all aspects of member details, compliance, and socio-economic factors. Proactive outreach and barrier removal are crucial. Plans should also prioritize clinical care, outcomes, and patient experience over operational performance.
investing in digital change and technological advancements is essential for data-driven decisions. Good data infrastructure enables better analysis, outreach, and provider performance recognition. Plans should also maintain close dialog with CMS and industry leaders to stay informed.
What’s next
By focusing on comprehensive member care, outcomes, innovation, and stakeholder input, healthcare providers can position themselves for success, regardless of changes to the Star Ratings program. Proactive and comprehensive care can lead to better health outcomes and member satisfaction.