Blue Cross and Blue Shield of Louisiana has lost its most recent bid challenging how CMS calculated its 2025 Medicare Advantage star rating.
On June 26, the U.S. Court of Appeals for the D.C. Circuit upheld a July 2025 district court decision that found CMS acted within its authority when it gave a 3.5-star rating to the insurer after it consolidated two MA contracts in 2024. The plan serves approximately 30,000 Medicare beneficiaries in Louisiana.
At the center of the dispute was how CMS evaluates special needs plan care management. The agency initially did not include data from the discontinued contract in the 2025 rating but later reversed course after BCBS argued the data should be used, expecting it would boost the plan’s overall score. Instead, the plan received a lower-than-expected score on the SNP measure, and its overall star rating stayed at 3.5 stars.
In its original complaint against the government, BCBS claimed CMS violated its own rules by including the data. The appeals court upheld the lower court’s finding that CMS followed its regulations, which require using data from both contracts during the first two years after a consolidation. The court also rejected BCBS’ argument that the discontinued contract should be treated as a terminated contract under CMS rules.
The ruling comes as star ratings litigation over 2026 ratings continues to escalate. In late May, a federal judge found CMS improperly used 20 measures when calculating Clover Health’s 2026 rating, spurring CMS to voluntarily recalculate certain scores. Elevance Health then sued CMS this month, arguing the agency applied a more favorable recalculation methodology to Clover than to other plans.
Becker’s has reached out to BCBS Louisiana for comment and will update this article if more information becomes available.
At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration. Apply for complimentary registration now.
