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HHS/CMS RIN: 0938-AT97 Publication ID: Fall 2019 
Title: Proposed Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Program for Contract Year 2021 (CMS-4190-P) 

This proposed rule would implement changes to strengthen and improve the Medicare Advantage (Part C) and prescription drug (Part D) programs, and it would also implement related provisions of the Support for Patients and Communities Act.

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: Other 
CFR Citation: 42 CFR 422 and 423   
Legal Authority: 42 U.S.C. 1302    42 U.S.C. 1395hh    Pub. L. 115-271   
Legal Deadline:
Action Source Description Date
Final  Statutory  Support for Patients and Communities Act  01/01/2021 

Overall Description of Deadline: Rule includes provisions of the "Support for Patients and Communities Act" required to be implemented by 01/01/2021.

Statement of Need:

This rule is necessary to make revisions to the Medicare Advantage (MA or Part C) program, Medicare Prescription Drug Benefit (Part D) program, Medicaid program, Medicare Cost Plan program, and Programs of All-Inclusive Care for the Elderly (PACE) to implement certain sections of the Bipartisan Budget Act (BBA) of 2018, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, the 21st Century Cures Act, and other changes based on our continued experience in the administration of the programs.

Summary of the Legal Basis:

This rule addresses multiple sections of the Social Security Act, the Bipartisan Budget Act of 2018, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, and the 21 st Century Cures Act.


This rule implements provisions that require public notice and comment and are necessary for the upcoming contract year.  We will continue to explore additional alternatives as we develop the rule.

Anticipated Costs and Benefits:

Preliminary estimates of the anticipated costs and benefits of this proposed rule indicate some savings and burden reduction for the government, MA organizations, prescription drug plan sponsors, and providers. Numerical estimates are pending as the Office of the Actuary is currently performing a detailed analysis of each provision.  As we move toward publication, estimates of costs and benefits will be included in the proposed rule. 


Risks of the proposals in this rule are still under development and will be included in the published rule for comment.

Action Date FR Cite
NPRM  12/00/2019 
Regulatory Flexibility Analysis Required: No  Government Levels Affected: None 
Federalism: No 
Included in the Regulatory Plan: Yes 
RIN Data Printed in the FR: No 
Agency Contact:
Heather Barkes
Acting Director, Division of Policy, Analysis, and Planning
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Medicare, MS: C4-21-26, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-8615