A newly introduced House bill is targeting the methodology behind Medicare Advantage star ratings, adding more pressure to a program that has seen years of litigation from insurers.
The Medicare Advantage Strengthening Transparency and Accountability in Rating Systems Act, or MA STARS Act, was introduced Sept. 21 by Rep. Mike Kelly, R-Pa., and would direct the federal government to rewrite star ratings policy beginning with the 2031 contract year.
Under the bill, CMS would have to exclude any measure that is unrelated to clinical quality, outcomes or experience, or is not reasonably attributable to the actions of the plan and its delegated entities, such as contracted providers and subcontractors. Measures built on enrollee surveys would also be excluded if the survey has more than 10 questions, fails to draw responses from a diverse group, or misses minimum response and sampling standards set by HHS.
Measures that no longer distinguish performance among most contracts would also come out of the calculations, while new measures could be added only if they relate to clinical quality, outcomes or experience.
Over the last several years, CMS has been facing litigation from insurers over how it calculates the ratings, which lead to bonus payments for high-rated contracts. In 2024, wins by SCAN and Elevance Health led the agency to recalculate ratings for every MA contract, while challenges to the 2025 ratings produced mixed results for the industry.
In May, a federal judge in Georgia ruled that CMS improperly included 20 measures in Clover Health’s 2026 rating, finding the agency lacked authority for 10 of them and skipped notice-and-comment rulemaking for the other 10. CMS raised Clover’s PPO contract from 3.5 to 4.5 stars and recalculated other plans’ ratings, but only where scores would improve and using a different set of measures. CMS’ 2027 MA rule removes 11 measures the agency described as administrative or lacking meaningful variation, mostly starting with the 2029 ratings.
For the 2027 ratings released in October, 15 contracts earned five stars, down from 22 in 2026, and 37% of contracts reached four stars or higher, compared with about 44% in 2026. The enrollment-weighted average rating slipped to 3.99 from 4.01 in 2026. Alignment Healthcare has already sued CMS over the 2027 ratings, arguing it could lose more than $200 million in 2028 bonus payments.
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