BHA Stars Litigation Tracker

After CMS released the 2027 Star Ratings on October 8, multiple MA plans have sued CMS, picking up where last year’s Clover challenge left off. All plans argue the same core point: CMS used measures it never adopted through notice-and-comment rulemaking, and some measures rely on data Congress didn’t authorize. But no two plans are challenging the same list. Each has picked the measures that pull its own ratings down, and together they claim more than multiple billions of dollas lost in 2028 QBP and rebate dollars.

Summary

Tracking the Measure Sets

Every suit builds on one of three baseline sets of measures:

Clover Holding 1 (statutory authority): The court held that CMS can base Star Ratings only on data collected under §1395w-22(e). That means HEDIS, HOS and CAHPS as they existed in 2003. It struck 10 measures that rely on other data: the appeals and call center measures, Part D CAHPS, Part D adherence, MTM and SUPD.

Clover Holding 2 (notice-and-comment): The court held that measure specifications set payment, so CMS must adopt them through formal rulemaking. It struck 10 CAHPS and HOS measures that were set only in the Technical Notes: Flu Vaccine, Physical Health, Mental Health, Falls, Bladder Control, Getting Needed Care, Appointments & Care Quickly, Customer Service, Rating of Health Care Quality and Care Coordination.

CMS June 17 memo: CMS voluntarily recalculated the 2027 QBP ratings using only HEDIS, CAHPS and HOS data. It removed 18 measures, which are all Part D measures plus 6 Part C admin measures. It applied a hold-harmless rule, so only increases counted. It did not apply Holding 2, and it did not change the 2027 Star Ratings.

Here is the full measure by measure tracker capturing every set:

Want to know what these measure sets would do to your own ratings? BHA’s Scenario Manager and Stars Planner run the Star Rating and QBP calculations automatically, so health plans can test any combination of measures and see the impact on their contracts. Reach out to us via email or Linkedin to test your scenarios.

Sources:

• Clover Insurance Co. v. HHS (S.D. Ga., 2:25-cv-00142)
• Clover Insurance Co. v. HHS (11th Cir. appeal)
• Alignment Healthcare v. HHS (D.D.C., 1:26-cv-03550)
• Healthfirst Health Plan v. HHS (S.D.N.Y., 1:26-cv-09158)
• Centene Corp. v. HHS (S.D. Ga., 2:26-cv-00113)
• SCAN Health Plan v. HHS – SCAN II (D.D.C., 1:26-cv-03737)
• CVS Health Corp. v. HHS (S.D. Ga., 2:26-cv-00115)
• CMS 2027 Star Ratings Measures