CMS Releases Contract Year 2027 Medicare Advantage and Part D Proposed Rule (SNF)
The Centers for Medicare and Medicaid Services (CMS) released the Contract Year 2027 Medicare Advantage and Part D Proposed Rule (CMS-4212-P), outlining several changes to modernize the Medicare Advantage (MA) program and foster marketplace competition. In addition to the Inflation Reduction Act (IRA) mandated Part D changes, key proposals include significant adjustments to Star Ratings measures, recission of certain marketing restrictions, new special enrollment period when a beneficiary’s key provider is no longer in-network, and three Requests for Information including one focused on duals to assess how C-SNP and I-SNP enrollment trends may affect state integration.
Proposed Star Ratings Changes: CMS plans to shift from process-focused measures to outcome measures that deliver greater beneficiary value. CMS proposes removing 12 administrative performance measures, noting that these measures have shown consistently high performance and therefore do not differentiate performance among providers. Additionally, CMS proposes adding a new measure for Depression Screening and Follow-Up starting in 2027.
Requests for Information: CMS seeks feedback on modernizing MA risk adjustment and quality bonus payments; improving integration of Medicare-Medicaid benefits for dually eligible SNP enrollees, spurred by the growth in the number of duals in C-SNPs in particular but also in I-SNPs; and advancing well-being through tools and incentives that support emotional health, social connection, preventive care and nutrition. The rule also contains proposed changes to certain D-SNP policies and well as feedback on additional MA policies such as network adequacy and medical loss ratio.
More information on the rule is available; an AHCA member login and password are required. A CMS press release and fact sheet are also available.