HEDIS MY 2027 Public Comment: Key NCQA and CMS Updates for Health Plans

For health insurance providers and policymakers, the annual cycle of quality measurement is more than a bureaucratic exercise; It’s the primary lens through which the efficacy of patient care is viewed. The current window for the HEDIS MY 2027 Public Comment period represents a critical juncture for health plans to influence the standards that will define their performance and reputation in the coming years.

The Healthcare Effectiveness Data and Information Set (HEDIS), sponsored and maintained by the National Committee for Quality Assurance (NCQA), serves as the gold standard for measuring performance in the U.S. Healthcare system. As the industry moves toward a more integrated, data-driven approach, the proposals for Measurement Year (MY) 2027 signal a definitive shift toward digital and outcomes-focused measurement, moving away from legacy reporting methods.

These updates do not exist in a vacuum. Simultaneously, the Centers for Medicare & Medicaid Services (CMS) is proposing its own set of measure retirements and additions for the Exchange MY 2026 Quality Rating System (QRS) reporting program. For health plans, navigating these overlapping requirements is essential for maintaining high ratings and ensuring operational compliance.

The Shift Toward Digital and Outcomes-Focused Measurement

The NCQA’s proposals for MY 2027 are designed to modernize how quality is tracked. By proposing a wide range of updates—including novel measures and modifications to existing ones—the NCQA is steering the industry toward a model that prioritizes actual patient outcomes and leverages digital health data. This transition is intended to reduce the administrative burden on providers while increasing the accuracy of the data collected.

This evolution is particularly relevant for specialized populations. For instance, CMS contracts with the NCQA to collect HEDIS measures specifically from Medicare Special Necessitate Plans (SNPs) to monitor quality in areas such as heart disease, behavioral health, and diabetes via CMS.gov. By utilizing these performance data sets, SNPs can identify performance gaps and establish realistic targets for clinical improvement.

Decoding the NCQA Health Plan Ratings 2027 Timeline

Understanding the trajectory from public comment to final rating is vital for strategic planning. The NCQA has established a rigorous schedule for the 2027 ratings, which encompass commercial, Medicare, and Medicaid health plans. The 2027 Methodology and the required Performance Measure List were both released on March 27, 2026 via NCQA.

The path to the final rating follows a strict sequence of deadlines and verification steps:

• Early May: Plan Confirmation. All plans, regardless of accreditation status, must review their organizational information, state coverage, and submission IDs. Plans are given 10 business days to confirm this data.
• June 15: HEDIS and CAHPS Submission. Here’s the hard deadline for submitting data as defined in the HEDIS Volume 2 Technical Specifications.
• Early August: Projected Ratings. Plans must review their projected ratings within 10 business days to allow the NCQA to finalize the review process.
• September 15, 2027: Official Release. The final 2027 Ratings are released electronically, providing consumers with data to inform their choices during open enrollment via NCQA.

How Performance Ratings are Calculated

The final numerical rating is not based on HEDIS data alone. Instead, the NCQA utilizes a weighted average that combines HEDIS measure ratings with Consumer Assessment of Healthcare Providers and Systems (CAHPS) measure ratings. This ensures that both clinical outcomes and the member’s experience of care are represented in the final score.

Beyond the weighted average, plans can earn bonus points if they hold a current Accreditation status as of the last business day in June of the release year. This accreditation serves as a marker of a plan’s overall commitment to quality management and operational excellence.

But, not all plans receive a numerical score. A plan may be flagged as “Partial Data Reported” if more than 50% of the weight of its submitted measures are marked as “NA” or “NB,” or if the plan fails to submit either HEDIS or CAHPS data. Such gaps in reporting can significantly impact a plan’s perceived quality and competitiveness in the market.

Impact on Stakeholders and Health Policy

The implications of the HEDIS MY 2027 updates extend beyond the administrative offices of health plans. For patients, these changes mean that the “star ratings” or numerical scores they see during enrollment are increasingly reflective of real-world outcomes rather than just process-based checkboxes.

For healthcare providers, the shift toward digital measurement may streamline how they report data, potentially reducing the manual effort required to prove quality of care. For the broader public health landscape, the inclusion of measures targeting chronic conditions—such as colorectal cancer screening and the pharmacotherapy management of COPD exacerbation—ensures that high-risk populations receive standardized, evidence-based care.

As we move forward, the next critical checkpoint for health plans is the Plan Confirmation process beginning in early May. During this phase, plans must be meticulous in reviewing their submission IDs and accreditation status to avoid errors that could jeopardize their final ratings.

Do you have questions about how these measurement changes will affect your healthcare coverage or plan performance? Share your thoughts in the comments below or share this analysis with your professional network.