MA STARS Act

[Congressional Bills 119th Congress] [From the U.S. Government Publishing Office] [H.R. 10521 Introduced in House (IH)]

<DOC>

119th CONGRESS 2d Session H. R. 10521

To direct the Secretary of Health and Human Services to revise the regulations implementing the 5-star rating system under Medicare Advantage.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

September 21, 2026

Mr. Kelly of Pennsylvania introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

A BILL

To direct the Secretary of Health and Human Services to revise the regulations implementing the 5-star rating system under Medicare Advantage.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Medicare Advantage Strengthening Transparency and Accountability in Rating Systems Act'' or the ``MA STARS Act''.

SEC. 2. REVISING REGULATIONS IMPLEMENTING MEDICARE ADVANTAGE 5-STAR RATING SYSTEM.

(a) In General.--The Secretary of Health and Human Services shall, through notice and comment rulemaking, revise sections 422.160 through 422.166 of title 42, Code of Federal Regulations, to provide that, in implementing the Star Ratings program with respect to an MA-only contract or an MA-PD contract, for the 2031 contract year and each subsequent contract year, the calculation of Star Ratings for such year shall-- (1) exclude any measure that-- (A) the Secretary determines is not related to clinical quality, patient outcomes, or patient experience for individuals enrolled under the contract; (B) the Secretary determines is not reasonably attributable to actions of the issuer and its delegated entities, consistent with program guidance; (C) is based on data from a survey distributed to individuals enrolled under the contract if such survey-- (i) includes more than 10 questions; (ii) does not yield responses from a geographically, demographically, and socioeconomically diverse set of individuals; or (iii) fails to meet such minimum response, sampling, or representativeness criteria as the Secretary determines necessary to implement clause (ii); or (D) the Secretary determines is no longer competitive as a metric for the majority of MA-only contracts and MA-PD contracts, and the continued inclusion of which would not differentiate performance among such contracts; (2) only include measures newly added to the Star Ratings program for such year that the Secretary determines are related to clinical quality, patient outcomes, or patient experience; and (3) with respect to any measure excluded under paragraph (1)(D), include such measure in the Star Ratings program as a display-only measure, including by publicly reporting performance on such measure in a form and manner determined appropriate by the Secretary. (b) Beneficiary Survey Technical Expert Panel.--The Secretary shall establish a technical expert panel, consistent with subsection (e), to evaluate and recommend the use of statistically sound beneficiary survey instruments as data sources for measures in the Star Ratings program. Such panel shall-- (1) identify survey instruments that-- (A) are developed, endorsed, and maintained by a third-party quality measure organization or Federal agency, such as the National Committee for Quality Assurance or the Agency for Healthcare Research and Quality; (B) have relevance to clinical quality, patient outcomes, or patient experience; (C) yield responses from a geographically, demographically, and socioeconomically diverse set of individuals; and (D) are designed to meet such minimum response, sampling, or representativeness criteria as necessary to implement subparagraph (C), with consideration for the number and complexity of questions, average time to completion, modality and timing of survey delivery, and other factors that maximize survey response rates; (2) solicit relevant stakeholder feedback on the findings of its evaluation and recommendations, and provide opportunities for public comment; and (3) not later than 2 years after the date of enactment of this section, submit to the Secretary a report summarizing the findings of the evaluation and recommendations for statistically sound beneficiary survey instruments to use as data sources for measures in the Star Ratings program. (c) Distribution of Star Ratings Technical Expert Panel.--The Secretary shall establish a technical expert panel, consistent with subsection (e), to evaluate the methodology for calculating measure- level cut points and assigning overall Star Ratings. Such panel shall-- (1) solicit relevant stakeholder feedback on the findings of its evaluation and recommendations, including opportunities for public comment; and (2) not later than 2 years after the date of enactment of this section, submit to the Secretary a report on recommendations to reform such methodology in a manner that rewards performance and promotes competition. (d) Annual Public Report.--For the 2031 contract year and each subsequent contract year, not later than a date determined appropriate by the Secretary prior to the beginning of such contract year, the Secretary shall make publicly available a report describing the distribution of overall Star Ratings and the methodology used to establish cut points and assign such ratings for such contract year. Such report shall also include-- (1) a list of measures excluded from the calculation of Star Ratings for such contract year; and (2) for each such excluded measure, the basis for exclusion, including the applicable provision under subsection (a)(1), and a brief description of the Secretary's rationale for such exclusion, including any data or analysis relied upon, as determined appropriate by the Secretary. (e) Technical Expert Panel Composition.--In establishing any technical expert panel under subsection (b) or (c), the Secretary shall ensure a balanced representation of relevant stakeholders and experts, including, as appropriate, beneficiaries, caregivers, clinicians, provider organizations, facility representatives, measure developers, health insurance providers, researchers, government agencies, quality measurement experts, survey methodology experts and Medicare Advantage organizations of different sizes, ownership structures, geographic service areas, and delivery models. Such representation shall include consideration of nonprofit and other mission-driven organizations, organizations with provider-aligned care delivery arrangements, and organizations with local and regional market experience. (f) Definitions.--In this section: (1) MA-only contract; ma-pd contract; star rating.--The terms ``MA-only contract'', ``MA-PD contract'' and ``Star Rating'' have the meanings given each such term in the regulations under subpart D of part 422 of title 42, Code of Federal Regulations. (2) Delegated entity.--The term ``delegated entity'' means any provider, provider organization, subcontractor, or other entity to which an issuer delegates functions related to benefits administration, utilization management, quality improvement, or enrollee services. (3) Newly added.--The term ``newly added'', with respect to a measure, means a measure first included in the Star Ratings program for the applicable contract year and does not include a measure continued from a prior year, unless the Secretary designates such measure as newly added due to a material change in specifications. (4) Relevant stakeholders.--The term ``relevant stakeholders'' means individuals and entities with expertise or direct experience related to the Star Ratings program, including patients, caregivers, clinicians, provider organizations, facility representatives, measure developers, including third-party quality measure organizations and Federal agencies, health insurance providers, Medicare Advantage organizations of different sizes, ownership structures, geographic service areas and delivery models, including nonprofit and other mission-driven organizations, organizations with provider-aligned care delivery arrangements, and organizations with local and regional market experience, quality measurement experts, survey methodology experts, researchers, government agencies, and individuals with expertise in rural and urban health care delivery. (5) Secretary.--The term ``Secretary'' means the Secretary of Health and Human Services. (6) Star ratings program.--The term ``Star Ratings program'' means the 5-star rating system under section 1853(o)(4) of the Social Security Act (42 U.S.C. 1395w- 23(o)(4)). <all>