The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule aimed at revising the Medicare Advantage (MA) Program, Medicare Prescription Drug Benefit Program (Part D), and Medicare Cost Plan Program for Contract Year 2027. The proposal, announced on November 25, 2025, seeks to enhance care quality and access for enrollees by updating Star Ratings and simplifying enrollment processes.
The proposed changes to the Star Ratings system include removing certain measures that focus on administrative processes with high performance and little variation. CMS plans to add a new Part C Depression Screening and Follow-Up measure to address behavioral health gaps. "These proposed changes aim to refocus the program on clinical care, outcomes, and patient experience where there is meaningful variation in performance across contracts," CMS said.
To improve the enrollment experience, CMS proposes modifications such as a new special enrollment period (SEP) for provider terminations. This would allow enrollees to change plans if their providers leave their network without needing significant network change approval from CMS.
Public feedback is being sought through three Requests for Information (RFIs). These RFIs aim to enhance competition within the MA program, address growth in chronic condition special needs plans (C-SNPs), and gather input on well-being and nutrition policy changes. "The RFIs seek comprehensive input from MA organizations, beneficiary advocates, healthcare providers, and industry experts," according to CMS.
CMS also proposes codifying provisions of the Inflation Reduction Act of 2022 related to Medicare Part D prescription drug benefits. Changes include eliminating the coverage gap phase and reducing out-of-pocket costs for enrollees in the catastrophic phase.
In addition, CMS aims to refine regulations regarding cannabis products under Special Supplemental Benefits for the Chronically Ill (SSBCI), aligning them with federal law. The agency is also proposing several regulatory burden reductions in line with Executive Order 14192.
A standalone RFI seeking public input on streamlining regulations is available at https://www.cms.gov/medicare-regulatory-relief-rfi. Comments can be submitted through this link.
For more details on the proposed rule, visit https://www.federalregister.gov/public-inspection/current.
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