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February 19, 2020



CMS Releases Advance Notice Part II and Proposed Rule on Contract Year 2021 and 2022 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicaid Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly
On February 5, 2020, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule and the Advance Notice Part II to “further advance the agency’s efforts to strengthen and modernize the Medicare Advantage and Part D prescription drug programs.” According to CMS, the changes would “lower beneficiary cost sharing on some of the most expensive prescription drugs, promote the use of generic drugs, and allow beneficiaries to know in advance and compare their out-of-pocket payments for different prescription drugs.”

The proposed rule would revise regulations for the Medicare Advantage (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 to implement certain sections of the Bipartisan Budget Act of 2018, the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act, and the 21st Century Cures Act. This proposed rule would also enhance the Part C and D programs, codify several existing CMS policies, and implement other technical changes. Comments on the proposed rule are due by April 6, 2020.

On the same day of the proposed rule release, CMS issued Part II of the Calendar Year (CY) 2021 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part C and Part D Payment Policies (the Advance Notice). CMS released Part I of the Advance Notice on January 6, 2020. CMS will accept comments on all proposals in the Advance Notice through Friday, March 6, 2020, before publishing the final Rate Announcement by April 6, 2020.

The proposed rule is available here.

The news release is available here.

A fact sheet on the CY 2021/2022 Medicare Advantage and Part D Proposed Rule (CMS-4190-P) is available here.

The Medicare Advantage and Part D Advance Notice Part II is available here.

The 2021 Medicare Advantage and Part D Advance Notice Part II Fact Sheet is available here.

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