Health Law Advisor

Several April releases seem to signal some basis for optimism for stakeholders in Medicare Advantage and Part D, though with sufficient undertones to recommend caution. In April, the Centers for Medicare and Medicaid Services (CMS) released its Final Rule on CY 2026 Policy and Technical Changes to the Medicare Advantage (MA) Program, Medicare Prescription Drug Benefit (Part D) Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (PACE) (the “2026 Final Rule)—and also released this CY 2026 Rate Announcement for MA and Part D. At approximately the same time, CMS posted an appeal for input on approaches and opportunities to streamline Medicare regulations and reduce unnecessary regulatory burden, providing MA and Part D stakeholders with an opportunity to highlight areas for potential change. 

Of particular note, the CY 2026 Rate Announcement includes a plan payment increase that is up more than $25 billion from its original proposal and continues the three-year phase-in of the move to the V28 risk adjustment model. This came just days after CMS issued the 2026 Final Rule. Created under a sharply different political landscape, the 2026 Final Rule departs from the Proposed Rule of November 26, 2024 (“2026 Proposed Rule”) in a number of ways.  

As we predicted in our previous Insight, the Trump Administration chose not to finalize some aspects of the 2026 Proposed Rule. The 2026 Final Rule balked at a number of proposals—owing at least in part to Executive Order 14192 of January 31, 2025, “Unleashing Prosperity Through Deregulation,” which was cited by CMS. With deferrals listed at 90 FR 15795 and 15892, the 2026 Final Rule is perhaps notable for

On March 15, 2019, the Centers for Medicare & Medicaid Services (CMS) released proposed changes to its methodology for calculating Civil Money Penalties (CMPs) for Medicare Advantage (MA) and Part D Prescription Drug Plan (MA and Part D) sponsors.  The proposed changes would impact both the calculation methodology for 2019 as well as the CMP amounts for 2019 and beyond in an effort to increase plan accountability.  CMS is accepting comments on these proposed changes until April 15, 2019 at 11:59 PM ET.

Though CMS has exercised its statutory and regulatory authority to impose CMPs on MA ...