HEDIS · Stars · RAF — 2026 Program Calendar

HEDIS

• MY2025 measurement year closed Dec 31, 2025 — 2026 is focused on hybrid record retrieval, abstraction, and NCQA submission.
• HEDIS has three distinct June milestones (UPDATED from original calendar):
  • Jun 1: All plan-locked data due in IDSS — this is the data lock, not the final submission.
  • Jun 15 at 9:00 pm ET: Final HEDIS MY2025 submission + signed attestation deadline. No late submissions allowed.
  • Jun 30: Last day for IDSS resubmission requests.
• NCQA compliance audit window runs June–July. Maintain audit-ready documentation of all hybrid records.
• ECDS/Hybrid transition: NCQA refined measure-specific pathways in January 2026, but the MY2029 endpoint for retiring Hybrid reporting remains unchanged. As of MY2025, eight measures still allow Hybrid reporting.

Stars (MA / PDP)

• The Stars rating lag is two years: CY2025 data feeds 2027 Star Ratings. Plans are working to optimize 2027 ratings now.
• CAHPS surveys run Feb–Mar; HOS runs Jun–Jul. Member experience is a dominant driver — CAHPS + HOS will make up nearly 40% of total Star weight by 2029.
• CMS typically previews 2027 ratings in Aug–Sep and publishes official ratings in October, immediately before AEP.
• CY2027 Final Rule (effective Jun 1, 2026) — major updates:
  • Four new measures added for 2027 Star Ratings: Colorectal Cancer Screening (respecified), Care for Older Adults–Functional Status Assessment, Concurrent Use of Opioids and Benzodiazepines, and Polypharmacy/Anticholinergic Medications in Older Adults.
  • Three measures removed from 2027 Stars (including MTM CMR completion rate).
  • Most structural changes — measure removals, weight shifts toward clinical outcomes — take effect in the 2027 measurement period and will inform 2029 Star Ratings, not 2027.
  • Health equity program requirements removed (DEI rollback): MA plans no longer required to include health disparity reduction activities in quality improvement programs.
  • Eye exam for diabetic patients retained after plan objections.
• Mar 31 CTM deadline (PASSED): Plans had until March 31 to request a review of 2025 Complaints Tracking Module data used in Stars calculations.

RAF / HCC Coding

• MA RAF: dates of service Jan 1–Dec 31, 2026 feed PY2027 risk scores. RAPS/EDPS submission is rolling all year with a final sweep in October.
• MA PY2026 final RAPS reconciliation window closes approximately Mar 31, 2026 — ensure all retrospective coding is submitted.
• ACA Marketplace RAF: diagnosis year 2025 data must be submitted by approximately Jun 30, 2026 for PY2026 payment reconciliation.
• Prospective HCC coding campaigns (AWVs, CCM, gap closures) should wrap up by October to ensure late-year claims are submitted before the DOS cutoff.
• HCC recapture rate and RAF accuracy are key levers for both MA revenue adequacy and Stars-adjacent quality metrics.