On April 2, 2026, CMS issued the CY2027 Medicare Advantage and Part D final rule, and its Star Ratings provisions are the most significant structural change to the program in several years. CMS will not implement the reward that was designed to replace the historical reward factor, it is removing 11 measures over the next two ratings cycles, and it is adding a new depression screening and follow-up measure. Together, the changes reshape where quality teams should invest for the 2028 and 2029 Star Ratings.
What CMS Finalized
The equity reward is out, the historical reward factor stays
Under prior rulemaking, CMS planned to replace the historical reward factor with a Health Equity Index reward, recently renamed the Excellent Health Outcomes for All reward, beginning with the 2027 Star Ratings. That reward would have recognized contracts for strong performance among enrollees with social risk factors, such as those who are dually eligible, receive the low-income subsidy or have a disability. The final rule does not implement it. Instead, CMS retains the historical reward factor, which rewards consistently high performance across all measures for all enrollees.
For many plans, this is a relief. Contracts that had been preparing for the equity reward, particularly smaller and regional plans and those with few members in the qualifying subgroups, faced uncertainty about whether they would meet minimum enrollment thresholds. Plans that had invested heavily in subgroup performance should keep those programs, since the underlying measures still count, but the specific bonus tied to subgroup results will not apply.
Eleven measures removed
CMS proposed in November 2025 to remove 12 measures. It finalized 11, declining to remove the Diabetes Care: Eye Exam measure, which stays in the program. The removed measures are largely administrative, process-focused or topped out. Timing differs by measure:
- Beginning with the 2028 Star Ratings: Statin Therapy for Patients with Cardiovascular Disease (Part C) and Call Center: Foreign Language Interpreter and TTY Availability (Parts C and D).
- Beginning with the 2029 Star Ratings (2027 measurement period): the remaining measures, including Complaints about the Health Plan and Complaints about the Drug Plan, Members Choosing to Leave the Plan (Parts C and D), Plan Makes Timely Decisions about Appeals, Reviewing Appeals Decisions, Special Needs Plan Care Management and Medicare Plan Finder Price Accuracy.
Industry summaries differ slightly in how they count measures that appear in both Part C and Part D, so plans should confirm their contract-specific list against the final rule and the forthcoming Technical Notes. CMS has also made clear that removing a measure from the Star Ratings does not relieve plans of the underlying obligations, such as processing appeals on time.
A new depression screening and follow-up measure
CMS finalized a Part C Depression Screening and Follow-Up measure beginning with the 2027 measurement year and appearing in the 2029 Star Ratings. The measure assesses the share of members screened for clinical depression using a standardized instrument and, for those who screen positive, whether they received follow-up care within 30 days. CMS will display the screening and follow-up rates separately and score the average of the two.
What It Means Financially
CMS's regulatory impact analysis estimates that the Star Ratings changes will increase payments to plans by roughly $18.5 billion over ten years, largely through higher quality bonus payments. CMS expects the return to the historical reward factor to raise ratings enough to offset, for many contracts, the declines from removing measures on which performance is already very high.
The effect will not be uniform. Removing high-performing administrative measures shrinks the denominator, which increases the weight of each remaining measure. Contracts that relied on strong administrative and customer service scores to offset weaker clinical outcomes will find their overall rating more sensitive to HEDIS, medication adherence and patient experience results.
What It Means for Quality Strategy
- Re-weight the portfolio. Rebuild internal Star Ratings models without the removed measures for 2028 and 2029, and identify which remaining measures now carry the most leverage.
- Prepare for depression screening now. The 2027 measurement year begins in less than nine months. Screening must use a standardized instrument, and follow-up must occur within 30 days of a positive screen. That requires screening built into visit workflows, structured capture of results and a reliable path to follow-up, often involving behavioral health capacity the plan does not directly control.
- Do not abandon operational performance. Appeals, complaints and member experience still matter for compliance, CAHPS and retention, even when they no longer count directly.
- Keep the diabetes eye exam on the list. Some plans had begun deprioritizing it in anticipation of removal. It remains a scored measure.
- Watch future rulemaking. The final rule included requests for information on the broader Star Ratings and quality bonus payment structure, signaling more change ahead.
A Depression Measure Readiness Checklist
- Standardized screening tool embedded in annual wellness and primary care visit templates.
- Results captured as structured data, not free text.
- Positive screens automatically generate a follow-up task with a 30-day clock.
- Behavioral health referral capacity confirmed by region.
- Care management outreach for members without a primary care visit.
- Monthly tracking of screening and follow-up rates by provider group.
How a Platform Approach Helps
Measures like depression screening and follow-up are won or lost inside the visit and in the 30 days after. Curitics Health supports this with an Encounter Builder that includes validated screenings and quality-gap closure during the visit, HEDIS gap tracking and closure, and visual workflow automation that turns a positive screen into a routed, monitored follow-up task.
The Bottom Line
The CY2027 final rule simplifies the Star Ratings program and moves weight toward clinical outcomes and patient experience. Plans that update their measure models, build depression screening into care workflows now and keep operational discipline on removed measures will be best positioned when the 2029 ratings arrive.
