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in Star Ratings while the updated measure is proposed through rulemaking and included on the display page for at least two years as codified at § 422.164(d)(2). Commenters expressed mixed reaction to the development of a new ECDS-reported version of the measure. The comments focused on timing of these potential changes, having the legacy and new measures collected concurrently, ensuring feedback by interested parties as this work progresses, and having widespread testing of the measure to capture potential challenges. We have shared these comments with NCQA for their consideration. Care for Older Adults (COA): Functional Status Assessment and Medication Review (Part C). NCQA is reevaluating the COA measures with the goal of considering measure modifications and transitioning the measures to the ECDS-reporting method to align with NCQA’s strategic direction. This effort may result in new ECDS-reported measures for the functional status assessment and medication review indicators. Any potential new measures are planned for implementation in measurement year 2027 at the earliest, and NCQA plans to maintain the current COA measures alongside any new measures for a period of time to allow for transition. Commenters provided mixed feedback on transitioning these measures to ECDS- reporting method. Comments related to ensuring sufficient time for the transition, expanding the measures to include all Medicare Advantage enrollees, and making sure there is sufficient testing. We shared the feedback we received with NCQA for their review. CMS will provide more updates on NCQA’s work as more information is available. Monitoring Physical Activity, Reducing the Risk of Falling, and Improving Bladder Control (Part C). These are three HEDIS measures collected through the HOS. NCQA refers to these measures as Physical Activity in Older Adults, Fall Risk Management, and Management of Urinary Incontinence in Older Adults. NCQA is planning to reevaluate these for measurement year 2027 at the earliest, focusing on evaluating the relevance and evidence supporting use of these measures in Medicare patients under 65 years of age. If these measures are updated, it would be considered a substantive change as codified at § 422.164(d)(2). CMS would keep the legacy measures in Star Ratings while the updated measures are on the display page and the updated measures are proposed through rulemaking. There was mixed support related to expanding the age range, including comments related to combining the under 65 population with the over 65 population. We have shared this feedback with NCQA for their consideration. Diabetes Care – Blood Sugar Controlled (Part C). NCQA calls this measure Glycemic Status Assessment for Patients With Diabetes.36 This measure is part of the former Comprehensive Diabetes Care measure set. The HEDIS measure captures the percentage of members 18-75 years of age with diabetes (types 1 and 2) whose most recent glycemic status (hemoglobin A1c [HbA1c] or glucose management indicator [GMI]) was at the following levels during the measurement year: glycemic status <8.0% or glycemic status >9.0%. In the Star Ratings program

36 https://www.cms.gov/medicare/health-plans/medicareadvtgspecratestats/announcements-and-documents/371979854/2024 –see pages 156-158.