HFMA provides a detailed summary of the final rule that will revise regulations affecting Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), Medicare cost plans, and Programs of All-Inclusive Care for the Elderly (PACE). The final rule, published by CMS in the April 6, 2026, Federal Register, will implement changes to the Part D drug benefit stemming from the Inflation Reduction Act and the SUPPORT Act, make discretionary changes to the Medicare Advantage and the Part D drug benefit programs, and make changes to the Part C and Part D Quality Ratings Systems (Star Ratings). The rule also finalizes certain changes to dual-eligible special needs plans and chronic condition special needs plans. The rule also finalizes certain changes to dual-eligible special needs plans (D-SNPs) and chronic condition special needs plans (C-SNPs). The rule also finalizes several proposed policies aimed at administrative burden reduction consistent with Executive Order 14192. Lastly, the rule includes a request for information on Future Directions in Medicare Advantage (Risk Adjustment and Quality Bonus Payments).
These regulations are effective June 1, 2026, applicable to coverage beginning January 1, 2027.
