(Dec. 5, 2025) – CMS Proposes New Medicare Advantage Policies and Issues RFI
The Centers for Medicare & Medicaid Services released a proposed rule that would update Medicare Advantage and Medicare Part D prescription drug programs "to strengthen quality, improve access to care and foster innovation in benefit design." The proposal also includes major enhancements to the Star Rating system and improves the enrollment experience for contract year 2027.
Along with Medicare Advantage and Part D program changes, CMS issued a request for information on how CMS can "improve and modernize Medicare Advantage," including modifications to risk adjustments, quality bonus payment policies and the inclusion of wellness and nutrition policies.
Comments about the proposed rule or responses to the RFI are due by Monday, Jan. 26, 2026.
CMS Issues Final CY 2026 Home Health PPS and DMEPOS Updates
The Centers for Medicare & Medicaid Services released the Home Health Prospective Payment System payment and policy updates for calendar year 2026. CMS is reducing the home health agencies' payment update by 3 percent, which includes a temporary behavioral adjustment to recoup retrospective overpayments. CMS estimates the total retrospective payment adjustment will be about $4.7 billion through calendar year 2024. By implementing a 3 percent reduction, CMS is estimating $417 million of the total will be recouped in 2026.
The final rule also includes recalibration of the case-mix weights, updates the functional impairment levels, comorbidity subgroups and low-utilization payment adjustment thresholds and includes changes to the face-to-face encounter policy. Additionally, the rule includes changes in the Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program that are intended to protect the Medicare Trust Funds and lower co-pays for beneficiaries.
MLN Connects Provider eNews Available
The Centers for Medicare & Medicaid Services issued the following updates to MLN Connects Provider eNews: