H.R. 10521: Medicare Advantage Strengthening Transparency and Accountability in Rating Systems Act

This bill would require the Department of Health and Human Services to change how Medicare Advantage plan quality ratings are calculated, starting with the 2031 contract year.

What changes to the Star Ratings system

The Medicare Advantage 5-star rating system would be updated so that, when HHS calculates ratings for Medicare Advantage-only and Medicare Advantage prescription drug contracts, it must:

• Leave out measures that are not tied to clinical quality, patient outcomes, or patient experience.
• Leave out measures that are not reasonably attributable to the actions of the plan or entities the plan delegates work to.
• Leave out survey-based measures if the survey is too long, does not get responses from a geographically, demographically, and socioeconomically diverse group, or does not meet minimum response and sampling standards set by HHS.
• Leave out measures that are no longer competitive enough to distinguish among most plans.
• Only add new measures that HHS determines are related to clinical quality, patient outcomes, or patient experience.
• Treat some excluded measures as “display-only” measures, meaning they would still be publicly reported but would not count toward the star rating.

Expert panels and public input

The bill would require HHS to create technical expert panels to study two parts of the rating system:

• Which beneficiary survey instruments are statistically sound enough to be used in the Star Ratings program.
• How measure-level cut points and overall star ratings are calculated.

These panels would have to gather stakeholder feedback, allow public comment, and submit reports to HHS within two years of enactment.

Public reporting

Starting with the 2031 contract year, HHS would have to publish an annual report showing:

• The distribution of overall star ratings.
• The methodology used to set cut points and assign ratings.
• A list of any measures excluded from the calculation.
• The reason each measure was excluded and a brief explanation of the supporting data or analysis.

Who would be involved in the panels

The bill says the expert panels should include a balanced mix of stakeholders, such as beneficiaries, caregivers, clinicians, provider organizations, insurers, researchers, survey experts, government agencies, and Medicare Advantage organizations of different sizes and business models.

Relevant Companies

• UNH — UnitedHealth Group, through its UnitedHealthcare business, offers Medicare Advantage plans that would be directly affected by changes to the rating system.
• HUM — Humana is a major Medicare Advantage insurer and could be affected by changes to how plan quality scores are calculated and reported.
• CVS — CVS Health, through Aetna, sells Medicare Advantage plans that could be affected by revised rating rules.
• CNC — Centene operates Medicare Advantage plans in some markets and could be affected by changes to Star Ratings methodology.
• ELV — Elevance Health offers Medicare Advantage plans and could be affected by changes to how those plans are scored.
• MHK — Molina Healthcare offers Medicare Advantage plans in certain areas and could be affected by the revised rating framework.