CMS Finalizes Medicare Advantage Policy and Payment Rules

On April 4, the Centers for Medicare and Medicaid Services (CMS) issued the Contract Year 2026 Medicare Advantage and Medicare Part D Policy and Technical Changes final rule, which established key MA policies for the upcoming year as well as the Calendar Year 2026 MA Rate Announcement, which sets payment rates for contract year 2026. AHCA/NCAL is still reviewing the rules in detail but has developed a brief summary of each as it pertains to long term and post-acute care. (Please note that a member login is required to view the summary.)

MA Policy and Technical Changes: The final rule primarily finalizes the required provisions related to implementing the Inflation Reduction Act. CMS finalized key provisions, including:

• Closing MA Appeals Loopholes.
• Limiting the Reopening of MA Hospital Admission Decisions
• Non-Allowable Special Supplemental Benefits for the Chronically Ill.
• Improvements to Care for Duals.

The rule does not include certain provisions such as health equity analysis of utilization management policies, further clarifications on MA plans use of internal coverage criteria, requirements of Medicare and Medicaid coverage of anti-obesity medications, and ensuring fair access to MA services by establishing guardrails on artificial intelligence.