On Friday, April 4, the Centers for Medicare and Medicaid Services (CMS) issued the Contract Year 2026 Medicare Advantage and Medicare Part D Policy and Technical Changes final rule, which establishes key MA policies in the upcoming year and on Monday, April 7 per the statutory deadline, the Calendar Year 2026 MA Rate Announcement, which sets payment rates for contract year 2026. AHCA/NCAL is still reviewing the rules in detail but has developed a brief summary of each as it pertains to long term and post-acute care. (Please note that a member log-in is required to view the summary.)
MA Policy and Technical Changes
The final rule is primarily finalizing the required provisions related to the implementation of the Inflation Reduction Act. CMS did finalize some key provisions, including:- Closing MA Appeals Loopholes
- Limiting the Reopening of MA Hospital Admission Decisions
- Non-Allowable Special Supplemental Benefits for the Chronically Ill
- Improvements to Care for Duals
The rule does not include certain provisions such as health equity analysis of utilization management policies, further clarifications on MA plans use of internal coverage criteria, requirements of Medicare and Medicaid coverage of anti-obesity medications, and ensuring fair access to MA services, by establishing guardrails on artificial intelligence.
MA Payment RuleMedicare Advantage base rates are increasing by 5.06%. CMS is also completing the phase-in of the new risk adjustment model. More information about both of these is available in the AHCA/NCAL
MA summary.
Please contact AHCA/NCAL’s
Nisha Hammel with any questions regarding the MA rules.