The Centers for Medicare & Medicaid Services (CMS) on April 5 released the Contract Year 2026 Medicare Advantage (MA) and Medicare Part D Policy and Technical Changes Final Rule. The agency finalized several proposals, including those to implement vaccine and insulin cost-sharing changes included in the Inflation Reduction Act (IRA, P.L. 117-169, PDF), improve enrollee protections in inpatient settings by clarifying requirements for MA coverage determinations, and further integrate Dual Special Needs Plans (D-SNPs) by requiring integrated health risk assessments (HRAs) and member ID cards for both Medicare and Medicaid. These changes will take effect on June 3 and apply to coverage beginning Jan. 1, 2026.
Notably, the CMS opted not to finalize several proposals. The agency specifically stated they will not finalize proposals to revise the annual health equity analysis of utilization management policies, implement guardrails for artificial intelligence (AI), or provide coverage of GLP-1 medications for obesity in Medicare Part D plans and Medicaid. However, the CMS does intend to explore future rulemaking related to AI. The agency did not indicate whether they would finalize several additional proposals related to network adequacy, provider directories, cost sharing for behavioral health, marketing, and Medical Loss Ratio reporting.
Lastly, in accordance with the Jan. 31 Unleashing Prosperity Through Deregulation executive order, the agency outlined policies under consideration for deregulation, which include the health equity index reward for Star ratings, the annual health equity analysis of utilization management policies, requirements for MA plans to provide culturally and linguistically appropriate services, and quality improvement and HRAs focused on equity and social determinants of health.