Helping plans navigate the Medicare Advantage and Part D programs

Complete 2025 Data Validation of the CY 2024 Part C and D Reporting Requirements.

Release of guidance regarding CY 2025 renewal options, including crosswalks

Actuarial User Group Calls each Thursday.

Release of the CY 2026 MTM Program Guidance HPMS memo.

Release Requirements for 2026 PDE Certification Testing

Release of final CY 2026 Annual Notice of Change (ANOC)/Evidence of Coverage (EOC), Low Income Subsidy (LIS) rider, Part D Explanation of Benefits (EOB), formularies, transition notice, provider directory, and pharmacy directory models for all organizations

Release of CY 2026 AIP D-SNP models for certain states requiring integrated Medicare and Medicaid models

Release of the CY2026 Bid Upload Functionality in HPMS

Deadline for MA, MA-PD, MMP, and PDP plans to notify CMS of their intention to non-renew a county(ies) or region(s) for individuals but continue the county(ies) or region(s) for “800 series” EGWP members, to convert to offering employer-only contracts, or to reduce service areas at the contract level.

MA organizations with D-SNP look-alike plans submit CY 2025 transitions plans to CMS.

Release of CY 2026 Actuarial Certification Module in HPMS.

Release of CY 2026 Formulary Submission Module in HPMS.

Release of CY 2026 FRF Update.

Updated CY 2026 Bid Review Out-Of-Pocket Cost (OOPC) model reflecting the CY 2026 May FRF updates available for download to MAOs and Part D sponsors to assist in meeting meaningful difference (if applicable) and TBC evaluations prior to bid submission.

Qualification determinations provided to CY 2026 applicants for new contracts or service area expansions.

Release of the CY 2026 MTM Program submission module in HPMS.

Preliminary approval/rejection for D-SNP look-alike transitions.

Part D DMP OMS responses due for reports distributed on April 30, 2025.