CMS Unveils 2027 Rule To Refocus Medicare Advantage On Outcomes

Benzinga_recent_news11-26

The U.S. Centers for Medicare & Medicaid Services (CMS) proposed rule changes for the 2027 Medicare Advantage and Part D contract year. The goal is to refine plan performance metrics and simplify ...

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The system guides beneficiaries in comparing plan quality and determines Quality Bonus Payments and rebates.\nOn Tuesday, Medicare Advantage-Prescription Drug contracts are rated on up to 43 measures, Medicare Advantage-only plans on up to 33, and Part D plans on up to 12, spanning outcomes, intermediate outcomes, process, patient experience, and access.\nCMS is advancing major changes to the ratings framework. The agency plans to:\nThe changes would allow plans to concentrate on clinical care, measurable outcomes, and patient experience. It should also ease administrative tasks tied to measures that no longer differentiate performance.\nThe proposal also includes steps to simplify enrollment. CMS is recommending a new special enrollment period for Medicare Advantage enrollees whose providers leave their plan's network mid-year.\nThe adjustment removes the requirement that a network change be deemed \"significant.\" This makes it easier for beneficiaries to switch plans while keeping their preferred providers, the agency explained.\nAdditionally, CMS plans to codify its long-standing policy that specific special enrollment periods require prior agency approval. \nRead Next:\nImage: Shutterstock","kind":"highlight","is_publish_news":true,"is_publish_highlight":false,"is_publish_live":false,"is_publish_wemedia":null,"editions":null,"column":"","sentiment":"0","news_tag":"","news_rank":0,"symbols":[],"gpt_button":0,"need_auth":false,"code":"91000000","status":"200"},"commentList":[],"isCommentEnd":true,"newsSizeData":{"likeSize":0,"commentSize":0,"repostSize":0,"favoriteSize":0,"likeStatus":false,"favoriteStatus":false},"APP":{"userAgent":"Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)","isDev":false,"isTTM":true,"deviceId":"web-server-community-laohu8-v3","version":"4.35.12","shortVersion":"4.35.12","platform":"web","vendor":"web","appName":"ttm","isIOS":false,"isAndroid":false,"isTiger":false,"isTHS":false,"isWeiXin":false,"isWeiXinMini":false,"isWeiBo":false,"isQQ":false,"isBaiduSwan":false,"isBaiduBox":false,"isDingTalk":false,"isToutiao":false,"isOnePlus":false,"isHuaWei":false,"isXiaomi":false,"isXiaomiWebView":false,"isOppo":false,"isVivo":false,"isSamsung":false,"isMobile":false},"href":"/m/news/2586636352","isCrawlerRequest":true}