CMS publishes CY 2027 MA and Part D proposed rule

CMS released the contract year (CY) 2027 Medicare Advantage (MA) and Part D proposed rule to detail potential updates to quality measures, drug coverage, enrollment processes, and more.

The agency is proposing significant changes to the Medicare Star Ratings system, including halting its plans to implement the Excellent Health Outcomes for All reward in the 2027 Star Ratings. This reward is designed to incentivize MA plans for providing high-quality care to patients with certain social risk factors. Additionally, for the 2027 measurement year, CMS is looking to remove 12 measures and add a new depression screening/follow-up measure to address behavioral health gaps.

CMS is also proposing improvements to enrollment processes through two key provisions. The agency is calling to modify a special enrollment period (SEP) for enrollees to change plans when one or more of their providers are leaving their plan’s network. This change would remove the limitation on the existing SEP requiring MA organizations and CMS to deem the network change to be “significant.” The second proposal is to codify existing policy that states certain SEPs require prior approval from CMS.

For Part D, CMS is hoping to codify several prescription drug benefit changes that are currently authorized through 2026 via the Inflation Reduction Act. These changes include eliminating the coverage gap phase, establishing a reduced annual out-of-pocket threshold, implementing the Manufacturer Discount Program, and more.

CMS is proposing several changes to comply with a recent executive order, including the following:

• Exempting health reimbursement arrangements and other account-based plans from creditable coverage disclosure requirements
• Removing the requirement for MA quality improvement programs to include activities that reduce health disparities
• Eliminating health equity requirements for MA utilization management committees

To get input on MA program enhancements and opportunities to better serve dually eligible beneficiaries, CMS added three requests for information in the proposed rule on the following topics:

• Risk adjustment and quality bonus payment changes to promote competition
• Concerns and solutions regarding the significant growth in enrollment in chronic condition special needs plans
• Well-being and nutrition policy changes that could improve preventive care

Comments on the rule are due by January 26, 2026. Revenue cycle professionals can view CMS’ fact sheet and press release on the CY 2027 MA and Part D proposed rule for more information.