The Centers for Medicare & Medicaid Services (CMS) issued the Contract Year (CY) 2027 Medicare Advantage (MA) and Part D Policy and Technical Changes proposed rule on Nov. 25. Comments on the proposed rule are due to the agency by Jan. 26, 2026.
Medicare Part D proposals focus on codifying changes as required by the Inflation Reduction Act (P.L. 117-169). MA proposals focus on updating and streamlining STAR rating measures, introducing new enrollment flexibilities to qualify for special enrollment periods, and rolling back health equity requirements including those related to MA utilization management committees and MA quality improvement programs. The CMS also proposed removing restrictions on risk adjusted MA data, including encounter data. This change would make MA data more accessible and apply the similar requirements for accessing as fee-for-service data. The AAMC has previously requested the CMS make MA data more accessible to external stakeholders [refer to Washington Highlights, May, 24, 2024].
The agency included several requests for information to inform future rulemaking. These requests seek information from stakeholders on opportunities to modernize risk adjustment models and quality bonus payment, how to address high dual-eligible concentration growth in chronic condition special needs plans and institutional special needs plans, and opportunities to improve enrollee well-being with a focus on nutrition and preventative care. The CMS expressed interest in making changes in these areas through regulatory changes or CMS Innovation Center models.