CMS CY 2027 Final Rule: Star Ratings Overhaul - What Compliance Teams Need to Know

The Short Version

CMS proposed removing 12 measures. After public comment, they kept one (Diabetes Care–Eye Exam) and finalized the removal of the other 11. Their reasoning is straightforward: these measures have “topped out” (performance is consistently high across contracts with limited variation), or they're administrative and operational in nature rather than focused on clinical outcomes or patient experience.

Separately, CMS decided not to implement the Health Equity Index (HEI) reward, sometimes called “Excellent Health Outcomes for All.” Instead, the historical reward factor stays in the methodology. We'll get into what that means for ratings below.

Which Measures Are Going Away

The removals happen on two timelines. Three measures come out starting with the 2028 Star Ratings. The other eight come out starting with the 2029 Star Ratings (2027 measurement year).

Gone Starting 2028

Gone Starting 2029

The One They Kept: Diabetes Care–Eye Exam

This is the interesting one. CMS proposed removing it, but commenters pushed back hard. The argument: diabetic retinopathy is a leading cause of preventable blindness, and this is the only vision-focused measure in Star Ratings. CMS agreed. In the final rule, they said keeping it will “help maintain plan accountability, support access to preventive screening, and encourage care coordination and innovation in screening approaches, particularly for high-risk and underserved populations.” It stays.

HEI Reward: Not Moving Forward

The Health Equity Index reward was codified at §§ 422.166(f)(3) and 423.186(f)(3) but never actually went live. It was designed to incentivize plans to improve outcomes for underserved populations. CMS finalized that the HEI reward will not be implemented. The historical reward factor at §§ 422.166(f)(1) and 423.186(f)(1) stays in place instead. This takes effect with the 2027 Star Ratings.

So What Happens to Ratings?

CMS ran simulations using 2025 Star Ratings data. Here's the combined impact of the measure removals, the HEI decision, and keeping the historical reward factor:

On Quality Bonus Payments: 4% of contracts would gain QBP eligibility, 3% would lose it.

The math is a bit of a push-and-pull. Removing the measures alone would generally pull ratings down, because most plans scored well on them. But keeping the historical reward factor and not implementing the HEI pushes ratings back up. The net result is that most plans stay put, but about one in four takes a half-star hit.

Because fewer measures now drive the overall score, performance volatility increases. That raises the stakes for plans that are borderline on QBP eligibility or rely on stable rebate assumptions. A half-star swing that used to be cushioned by high-performing administrative measures is now more exposed.

It's Not Only Subtraction

Worth noting: CMS is also adding a new Part C measure, Depression Screening and Follow-Up, for the 2027 measurement year (impacting the 2029 Star Ratings). So the measure set is not just shrinking. CMS is refocusing it toward clinical outcomes and areas where performance still varies meaningfully across contracts.

Removed from Ratings, Not from Oversight

This is the part that matters most for compliance teams. CMS made a point of saying this repeatedly in the rule: taking a measure out of Star Ratings does not mean they stop watching.

What This Means in Practice

Key Dates

For plans, the takeaway is straightforward: removal from Star Ratings does not mean removal from scrutiny. The operational disciplines behind appeals, complaints, and data integrity still matter. That is where strong compliance infrastructure matters most.