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HHS/CMS RIN: 0938-AV24 Publication ID: Fall 2023 
Title: Contract Year 2025 Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, and Medicare Cost Plan Programs, and PACE (CMS-4205)  

This proposed rule would make changes to strengthen and improve the Medicare Advantage (Part C) and prescription drug benefit (Part D) programs, and Programs of All-Inclusive Care for the Elderly (PACE), and implement any legislative changes that are required by January 1, 2025.

Agency: Department of Health and Human Services(HHS)  Priority: Section 3(f)(1) Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Proposed Rule Stage 
Major: Yes  Unfunded Mandates: No 
CFR Citation: 42 CFR 422    42 CFR 423    42 CFR 460   
Legal Authority: Pub. L. 115-271   
Legal Deadline:  None

Statement of Need:

This proposed rule is necessary to amend the regulations for the Medicare Advantage (Part C) program, Medicare Prescription Drug Benefit (Part D) program, Medicare cost plan program, and Program of All-Inclusive Care for the Elderly (PACE) to implement certain statutory requirements, to codify existing subregulatory guidance, and 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 and proposes to codify existing Part C and Part D subregulatory guidance. It would also implement certain sections of the Bipartisan Budget Act of 2018 and the Consolidated Appropriations Act (CAA), 2023.


This rule would implement 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 minor costs (under $50 million) associated with increased paperwork as well as some savings to the Medicare Trust Fund. Numerical estimates are pending and as we move toward publication, estimates of costs and benefits will be included in the proposed rule.


Risks associated with the impact of this rule are under development and will be included in the published rule.

Action Date FR Cite
NPRM  11/15/2023  88 FR 78476   
NPRM Comment Period End  01/05/2024 
Regulatory Flexibility Analysis Required: Undetermined  Government Levels Affected: None 
Federalism: No 
Included in the Regulatory Plan: Yes 
RIN Data Printed in the FR: No 
Agency Contact:
Heather Barkes
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