The Alliance of Community Health Plans is requesting that CMS continue its hold harmless methodology for 2027 Medicare Advantage star ratings, according to a July 27 letter.
The trade group of nonprofit health plans called on CMS to calculate each contract’s overall rating two ways, using the methodology in place before the 2025 measurement year and a version that removes measures affected by Clover Health’s litigation. CMS would then designate the higher rating.
ACHP argued changing the methodology after health plans make investments based on a previously set protocol could unnecessarily reduce quality bonus payments and rebate revenue, despite stable plan performance.
Clover scored a recalculation of its largest contract’s star rating after challenging several measures in court. CMS then opted to reevaluate other plans’ ratings, only elevating the overall rating if there was an increase. Other plans pursued their own lawsuits as the recalculations got underway, with some pushing for even higher ratings. Shortly before the release of the revised ratings, though, CMS appealed the Clover judgment.
“Adopting a different methodology while the same legal questions remain unresolved would create inconsistency, increase uncertainty and produce inequitable results across contracts,” ACHP President and CEO Ceci Connolly said in the letter.
ACHP also advocated for more transparency with ratings, such as CMS sharing its interpretations of included and excluded measures based on the Clover decision. If CMS needs to permanently update its methodology, the agency should pursue notice-and-comment rulemaking or follow other guidance while giving plans an adequate transition period, the letter said.
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