Proposed Rule Re: Medicare Program; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly
On November 26, 2024, the Centers for Medicare & Medicaid Services (CMS) released for public inspection the above-named proposed rule to be officially published in the Federal Register on December 10, 2024. If finalized, this proposed rule would revise the Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), Medicare cost plan, and Programs of All-Inclusive Care for the Elderly (PACE) regulations to implement changes related to Star Ratings, marketing and communications, agent/broker compensation, health equity, dual eligible special needs plans (DSNPs), utilization management, network adequacy, and other programmatic areas. This proposed rule also includes proposals to codify existing sub-regulatory guidance in the Part C and Part D programs.
The purpose of the proposed rule:
- Amends the regulations for the Medicare Advantage (Part C) program, Medicare Prescription Drug Benefit (Part D) program, Medicare cost plan program, and Programs of All-Inclusive Care for the Elderly (PACE).
- Includes a number of new policies that would improve these programs beginning with contract year 2026 and proposes to codify existing Part C and Part D sub-regulatory guidance.
- New marketing and communications policies in this rule are proposed to be applicable for all contract year 2026 marketing and communications, beginning October 1, 2025.
- Includes tentative timelines to operationalize the proposed Format Provider Directories for Medicare Plan Finder provision.
- It is anticipated that that 2025 plan year directory data will need to be made available for testing purposes in the summer of 2025, and 2026 Plan year data would need to be available on October 1, 2026, with a proposed applicability date of July 1, 2025, for this provision. A limited number of the provisions in this rule are proposed to be applicable beginning with coverage on and after January 1, 2026.
Action: Review the proposed rule and determine if comments will be submitted. Comments on the proposed rule are due to CMS no later than 5 p.m. Eastern Time on January 27, 2025. Email [email protected] for an index to the proposed rule, along with highlights of its most significant provisions.
