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HHS/CMS RIN: 0938-AT08 Publication ID: Fall 2017 
Title: Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs for Contract Year 2019 (CMS-4182-P) 

This proposed rule would set forth programmatic and operational changes to the Medicare Advantage (MA) and prescription drug benefit programs for contract year 2019.

Agency: Department of Health and Human Services(HHS)  Priority: Economically Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Proposed Rule Stage 
Major: Yes  Unfunded Mandates: No 
EO 13771 Designation: Deregulatory 
CFR Citation: 42 CFR 417    42 CFR 422    42 CFR 423    42 CFR 483    ...     (To search for a specific CFR, visit the Code of Federal Regulations.)
Legal Authority: Pub. L. 114-198, sec. 702    Pub. L. 114-255, secs. 17005 & 17006    42 U.S.C. 1302    42 U.S.C. 1395hh   
Legal Deadline:  None

Statement of Need:

This rule is necessary to make revisions to the MA program (Part C) and Prescription Drug Benefit Program (Part D), and other changes to the regulations based on our continued experience in the administration of the Part C and Part D programs.

Summary of the Legal Basis:

This rule addresses multiple sections of the Social Security Act (including secs. 1102 and 1871) and the Public Health Service Act. It also implements section 704 of the Comprehensive Addiction and Recovery Act (CARA) and sections 17005 and 17006 of the 21 st Century Cures Act.


This rule proposes approaches to improve the quality, accessibility and affordability of the Medicare Part C and Part D programs and to improve the CMS customer experience. The Agency will consider options that support these improvements.

Anticipated Costs and Benefits:

The rule includes changes that support innovative approaches by Medicare Advantage (MA) organizations and Part D sponsors in administering the benefit and that prevent improper provision of services, implementing changes in line with the Comprehensive Addiction and Recovery Act of 2016 and the 21st Century Cures Act.  We believe the proposed changes will result in a reduction of burden to MA Organizations and Part D Sponsors and generate program savings. As we move toward publication, estimates of the cost and benefits of these provisions will be included in the rule.


If this regulation is not published timely, changes will not be in place for contract year 2019.

Action Date FR Cite
NPRM  11/00/2017 
Regulatory Flexibility Analysis Required: No  Government Levels Affected: Federal 
Small Entities Affected: Businesses, Governmental Jurisdictions, Organizations  Federalism: No 
Included in the Regulatory Plan: Yes 
RIN Data Printed in the FR: No 
Agency Contact:
Christian Bauer
Director, Division of Part D Policy
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Medicare, MS: C1-26-16, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-6043