In the wake of lawsuits by several Medicare Advantage plans over their Star rating scores based on how their customer call centers handled phone calls, the Centers for Medicare & Medicaid Services (CMS) plans to lower the weight of the measure.
During a talk this week at the Milken Institute’s 2024 Future of Health Summit in Washington, D.C., CMS Director of Medicare Meena Seshamani said that the agency has taken action to lower the weight of the call center measure. She said CMS is always evaluating the methodology of Star ratings to ensure they reflect quality of care, but it takes time to determine its impact.
According to a CMS download for the 2026 Star ratings measures, CMS will decrease the weight of patient’s experience and complaints, and capturing access measures (including call center measures) from 4 to 2 beginning with the 2026 Star ratings.
CMS has been under fire for 2025 Star ratings. UnitedHealthcare, Centene, and Humana have filed lawsuits over their lowered ratings due to the weight of customer call centers. UnitedHealthcare claims in its lawsuit that CMS downgraded its Star ratings based on an arbitrary and capricious assessment of how its call center handled a single phone call from a CMS test caller that lasted less than 10 minutes.
Industry expert Rex Wallace, CEBS, chief executive officer of Rex Wallace Consulting, LLC., who will discuss the latest legal challenges to Star ratings at the upcoming RISE Star Ratings Master Class told RISE during a recent interview that more plans may sue. “They’re not just suing because Stars is hard or doesn’t make sense," he said. "They’re suing for real, specific issues and the way the new regulations were rolled out.”