红领巾瓜报

The Centers for Medicare & Medicaid Services (CMS) released the听 on January 26, 2026. The Advance Notice begins CMS鈥檚 annual rate-setting cycle and describes proposed updates to Medicare Advantage (MA) growth rates, benchmark rebasing, risk adjustment, Star Ratings, and Part D payment parameters. CMS previously released a鈥�鈥痠n November听2025听that included policy changes听to the Star Ratings system听and enrollment policies for听MA and Part D听starting in听contract year听2027.听(Read听the听红领巾瓜报听(红领巾瓜报)听summary听here.)听

Comments on听the Advance Notice are due February 25, 2026, and听CMS will publish the final CY 2027听rate听announcement no later than April 6, 2026.听听

This article provides an early听look at the听proposed听methodological听updates and听draft capitation听rates.听Wakely, an 红领巾瓜报听Company, will publish a detailed analysis of the听Advance Notice听in early听February.听

Payment Impact on Medicare Advantage Organizations听

CMS estimates a national per capita听MA听growth rate of听5.10听percent from 2026 to 2027, with fee-for-service (FFS) non-end-stage renal disease (non-ESRD) growth of 5.10 percent and FFS dialysis end-stage renal disease (ESRD) growth of 6.17 percent.听

The听5.10听percent growth rate reflects projected increases in per听capita听FFS听Medicare spending for听beneficiaries who are听aged/have听disabilities听and serves as the primary driver of 2027 benchmark updates, interacting with rebasing and risk adjustment changes to听determine听final capitation payments.听The growth rate听reflects听updates听to听how CMS pays for skin substitutes听in the 2026 Medicare Physician听Fee听Schedule.听These updates resulted in significantly lower projected costs听and materially reduced听the growth听rate.听

These preliminary estimates inform the development of MA benchmarks and may change in the final听rate听announcement.听

Table 1. Estimated Impact of Proposed Payment Changes on Medicare Advantage Plan Payments, CY 2027听

听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听 听Year-to-Year Percentage Change听
Impact听听	CY 2027 Advance Notice听听
Effective Growth Rate	4.97%
Rebasing/Re-pricing	TBD
Change in Star Ratings	-0.03%
MA Coding Pattern Adjustment	0%
Risk Model Revision and Normalization	-3.32%
Sources of Diagnoses	-1.53%
Expected Average Change	0.09%
Source:听Centers for Medicare & Medicaid Services.听2027 Medicare Advantage and Part D Advance听Notice.听January 26, 2026.听Available at: https://www.cms.gov/newsroom/fact-sheets/2027-medicare-advantage-part-d-advance-notice.听

 

Medicare Advantage Benchmarks, Rebasing, and Risk Adjustment听

The Advance Notice describes CMS鈥檚听approach and听changes听that听will听affect payment听to听plans, including:听

• Excluding from the risk adjustment process diagnoses submitted from chart reviews with unlinked claim records. In the Fact Sheet, CMS estimates this change will reduce Part C payments by 1.53 percent.听
• Rebasing听county听FFS听rates for 2027 using 2020鈥�2024 claims data, continuing听CMS鈥檚听practice of updating benchmarks annually to reflect the most current FFS experience. The Advance Notice also reiterates the statutory framework for calculating benchmarks, including applicable and specified amounts, benchmark caps, and quality bonus payments.听
• Updating听the CMS Hierarchical Condition Category (CMS-HCC) and Prescription Drug Hierarchical Condition Category (RxHCC) risk adjustment models and associated normalization factors for CY 2027 and听continuing听to apply the statutory MA coding pattern difference adjustment to account for systematic differences in diagnosis coding between MA and FFS.听

Quality Bonus Payments, Star Ratings, and Part D Updates听

CMS听states听that contracts with 4 or more Stars receive a 5听percentage-point quality bonus, while new and low-enrollment contracts receive a 3.5percentage-point bonus. The Advance Notice also includes updates related to Part C and Part D Star Ratings measures and methodological refinements.听

For Part D, CMS outlines proposed updates to the defined standard benefit parameters for CY 2027, as well as changes to Part D risk adjustment, normalization, premium stabilization, reinsurance, and risk-sharing, with听additional听policy context provided in the Contract Year 2027 Medicare Advantage and Part D proposed rule.听

Connect听with Us听

The CY 2027 Advance Notice provides early signals on benchmark growth, rebasing, and payment听methodology听changes that will shape MA and Part D payments听in听2027. Stakeholders should begin evaluating the potential implications for bid development, benefit design, and financial performance as CMS moves toward听finalizing听rates in April.听

红领巾瓜报 supports Medicare Advantage and Part D stakeholders with payment impact modeling, scenario analysis, and strategic advisory services related to benchmark rebasing, risk adjustment, Star Ratings, and Part D payment policy to help organizations prepare for the CY 2027听rate听announcement.听

For details about the finalized payment and policy rules,听contact our featured experts,鈥�听听and听.听

The Centers for Medicare & Medicaid Services (CMS) Innovation Center听recently published applications for its new听 (Advancing Chronic Care with Effective, Scalable Solutions), a 10-year voluntary initiative beginning July 2026. The model is designed to advance outcomes-based, technology-enabled care delivery in Original Medicare and aligns with the Innovation Center鈥檚 priorities of strengthening prevention, empowering beneficiaries, and promoting performance-based competition. ACCESS is particularly suited to organizations with mature clinical operations and data infrastructure, offering a new pathway for tech-supported services.听

This article summarizes the model鈥檚听design, highlights key considerations for prospective applicants, and addresses听common questions听our Medicare and technology experts fielded听during听a recent Health Management听Associates (红领巾瓜报)/Leavitt Partners听webinar.听

What the ACCESS Model Is Testing听

ACCESS evaluates whether Outcome-Aligned Payments (OAPs)鈥攔ecurring payments contingent on measurable clinical improvement鈥攃an reduce spending while maintaining or improving quality for beneficiaries with chronic conditions. The model tests whether incentivizing technology supported care can produce reliable clinical outcomes while complementing traditional care delivery.听

Who听may听participate? Organizations must be Medicare Part B鈥揺nrolled providers or suppliers (excluding DMEPOS [Durable Medical Equipment, Prosthetics, Orthotics, and Supplies] and labs). Participants may enroll beneficiaries directly, operate across multiple clinical tracks, and manage all qualifying conditions within each selected track. Beneficiary participation is voluntary, and individuals may switch ACCESS participants every 90 days.听

Clinical tracks. At launch, the four clinical tracks reflect high-prevalence chronic conditions with established care pathways and strong evidence for technology-supported interventions:听

• Early Cardio-Kidney-Metabolic (eCKM)听
• Cardio-Kidney-Metabolic (CKM)听
• Musculoskeletal (MSK)听
• Behavioral Health (BH)听

Payment.听OAPs vary by track and performance period. CMS pays a听portion听prospectively听each quarter and withholds听50 percent听pending reconciliation based on:听

• Clinical outcomes attainment: The percentage of aligned beneficiaries who complete the 12鈥�month performance period and achieve track鈥�specific clinical targets relative to their baseline.听
• Substitute鈥�spend test: Ensures beneficiaries do not receive duplicative听fee-for-service (FFS)听services for conditions managed under ACCESS.听

Technology and data exchange. ACCESS听takes a听tech-forward听approach.听Key expectations听include听use of听Fast Healthcare Interoperability Resources (FHIR庐) based Application Programming Interfaces (APIs)鈥痜or eligibility, consent, claims sharing, and care coordination鈥攑art of the broader federal push to modernize the health data ecosystem. CMS also plans to publish a public directory that lists participants, tracks, cost-sharing policies, and risk-adjusted outcomes to enable consumer and clinician choice.听

Regulatory coordination. To complement ACCESS and expand the pipeline of听technology-supported听interventions,听the US Food and Drug Administration鈥檚听(FDA)听 (Technology-Enabled Meaningful Patient Outcomes) allows selected US-based digital health device manufacturers to participate while generating real-world evidence. Up to 40 device manufacturers may participate across clinical areas.听

This coordinated CMSFDA effort is intended to reduce barriers to innovation and accelerate access to safe, effective digital tools that can support chronic disease management.听

Key Considerations听for Applicants听

Program integrity and fraud/abuse. CMS has emphasized program integrity across Medicare and Medicaid, and ACCESS reflects that emphasis. Applicants and their parent organizations should expect rigorous screening. Participants must also operationalize controls to pass the substitute spend test and maintain auditable evidence of outcomes and beneficiary consent.听

Overlap with听Accountable Care Organizations (ACOs)听and other models. Patients may participate in ACCESS and be aligned with an ACO simultaneously; however, 鈥減articipant overlap鈥� raises important operational and financial issues. ACCESS includes an FFS exclusion policy that prohibits participants or affiliated entities from billing Medicare FFS for any services delivered to the same beneficiaries for the duration of their ACCESS episode. As a result, traditional providers, ACO-aligned clinicians, and integrated delivery systems must assess whether they can segment patient populations or if partnering is more feasible.听

Eligibility and clinical scope. ACCESS is focused on relatively stable, chronically ill beneficiaries and excludes those with more acute/severe conditions. Participants must accept responsibility for all qualifying conditions a beneficiary has within a track.听

Outcomes听performance. The听ACCESS Model places substantial听emphasis on clinical听performance听and care coordination. Participants听are paid in full only if enough patients hit outcomes targets.听Early cohorts will听likely skew听toward organizations with mature clinical protocols, robust engagement models, and听demonstrated听outcomes.听Applicants should听be听financially听prepared听to听tolerate withholds, beneficiary switching, and听follow-on听period payment reductions after year one.听

Digital infrastructure and interoperability. ACCESS presumes API-driven data exchange, including consent capture, eligibility checks, claims/clinical data integration, and bidirectional information sharing with the patient鈥檚 broader care team. Applicants should ensure they have a FHIR API server and meet the requirements described in the CMS .

Go-to-market and referral strategy. Beneficiary alignment is voluntary and will be facilitated by CMS鈥檚 planned public directory with risk-adjusted outcomes. Access participants will benefit from strong referral relationships鈥攅specially with ACOs and primary care providers鈥攂oth to enroll eligible beneficiaries and to minimize substitute services. A field strategy grounded in evidence, patient engagement, and interoperability with local providers is critical to success.听

Connect with听Us听

for the first ACCESS Model performance period are due April 1, 2026, with model launch in July 2026; applications submitted later would start January 1, 2027. Because ACCESS is a rolling, decade-long model, some organizations may choose to stage entry.听

ACCESS is the most explicit Innovation Center opportunity to date on outcomes-based, tech-enabled chronic care in Traditional Medicare. It offers digital health and advanced care organizations a direct line to FFS beneficiaries with payment tied to results, not activities. Success will favor teams that combine clinical excellence, consumer-grade engagement, and API-level interoperability, as well as manage program integrity, ACO overlap, and beneficiary churn.听

For questions or support assessing readiness, developing an application, or operationalizing the model, contact听Amy Bassano,听, or听Kate de Lisle.听