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This proposed rule would implement changes to strengthen and improve the Medicare Advantage (Part C) and prescription drug (Part D) programs.  It also proposes changes to the Medicare Cost Plan Program, Medicare Parts A, B, C, and D Overpayment Provisions of the Affordable Care Act, and Programs of All-Inclusive Care (PACE).  

Statement of Need:

This rule is necessary to make revisions to the Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), and PACE regulations to implement changes related to Star Ratings, medication therapy management, marketing and communications, health equity, provider directories, prior authorization, passive enrollment, network adequacy, identification of overpayments, formulary changes, and other programmatic areas. This proposed rule would also codify regulations implementing Section 118 of the Consolidated Appropriations Act of 2021 and includes a large number of provisions that would codify existing sub-regulatory guidance in the Part C, Part D, and PACE programs. This proposed rule would also amend the existing regulations for Medicare Parts A, B, C, and D regarding the standard for an identified overpayment.

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 Consolidated Appropriations Act of 2021.

Alternatives:

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

Anticipated Costs and Benefits:

As we move toward publication, estimates of costs and benefits will be included in the proposed rule. 

Risks:

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