Full Text
Official text as published. Use Ctrl+F / Cmd+F to search within the document.
[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>