Template Feedback & Directions: Medicare Half C & Half D Rule 

Leap to the template letter.

Directions 

The Facilities for Medicare & Medicaid Companies (CMS) has launched a proposed rule to make modifications to Medicare Benefit (Half C) and Prescription Drug Plans (Half D) plans. Your feedback are wanted to create a powerful document and make sure that your help or issues are heard. Justice in Getting old has created template feedback to information you.

This doc supplies a Glossary under of phrases and acronyms. For every space for commenting, we’ve supplied a abstract of the proposal and examples of what can be useful to incorporate in your feedback.

Please:  

• Tackle as few or as many areas as you want. Even one or two examples displaying the impression of one of many proposed modifications would assist. Organizations which have the bandwidth to go deeper—please do!    
• When you’ve got consumer tales or private experiences with the proposal that help your feedback, please ensure to incorporate them!  Please ensure to depart out particulars that would establish the particular person.  
• CMS values feedback which are distinctive. Please be happy to jot down the remark in your personal phrases.  
• Web page numbers discuss with the PDF web page quantity.   

Remark Deadline: January 26, 2026, at 5 pm Japanese / 2 pm Pacific. Observe that the timing of the deadline is earlier within the day than regular. Submit feedback right here. 

Glossary 

Twin Eligible Particular Wants Plan (D-SNP): D-SNPs are a subset of Medicare Benefit plans that particularly serve people dually enrolled in Medicare and Medicaid. D-SNPs are topic to federal oversight and should adjust to Medicare Benefit laws and steerage. Every D-SNP sponsor should enter right into a contract with the state Medicaid company during which the D-SNP operates. The extent to which D-SNPs coordinate with Medicaid varies. Coordination Solely, Extremely Built-in, Absolutely Built-in, and Relevant Built-in plans are all kinds of D-SNPs with totally different integration and coordination necessities. Learn extra in Twin Eligible Particular Wants Plans (D-SNPs): What Advocates Must Know.  

Particular Supplemental Advantages for the Chronically Sick (SSBCI): Gadgets and providers which have an inexpensive expectation of bettering or sustaining the well being or general perform of the chronically sick enrollee. SSBCI advantages are developed by Medicare Benefit plans and supplied to people who’ve a posh persistent sickness, have a excessive danger of hospitalization or different hostile well being outcomes, and require intensive care coordination.  

State Medicaid Company Contract (SMACs): Contracts, developed by a state, {that a} D-SNP should conform to as a way to function within the state. In keeping with federal guidelines, SMACs should embody the identical Medicare and Medicaid providers a D-SNP should cowl, the identical cost-sharing a D-SNP should cowl, and who’s eligible to enroll in a D-SNP.  

Template

Obtain as Phrase (.docx)

January 26, 2026

Facilities for Medicare & Medicaid Companies
Division of Well being and Human Companies
Consideration: CMS–4212– P
P.O. Field 8013, Baltimore, MD 21244– 8013.

Submitted electronically through laws.gov

Re: Medicare Program; Contract 12 months 2027 Coverage and Technical Modifications to the Medicare Benefit Program, Medicare Prescription Drug Profit Program (CMS 4212-P)

[Organization] appreciates the chance to supply feedback on the above-referenced Discover of Proposed Rule Making. [Describe your organization briefly].

[Organization] has many issues concerning the proposals within the above-referenced Discover of Proposed Rulemaking. These feedback particularly handle parts of these proposals affecting people dually eligible for Medicare and Medicaid, together with older adults and individuals with disabilities and the impression the modifications would have on the people that our group serves.

1. Reducing Consciousness of the State Well being Insurance coverage Help Program (SHIP)

Abstract: In part IV.E on web page 57 (entitled, “Updating Third-Occasion Advertising Organizations Disclaimer Necessities”), CMS proposes eradicating a language describing the SHIP in customary language that advertising organizations are required to make use of when talking with potential enrollees. Potential enrollees are nonetheless directed to 1-800 MEDICARE and Medicare.gov. In explaining this proposal, CMS signifies a powerful desire in opposition to referring to SHIPs, indicating that counselors could not have the experience to assist enrollees navigate complicated program points.

Useful areas to remark:

• Opposition to the proposed change. Assist for the SHIP program, together with examples of when SHIP counselors have helped resolve Medicare and Medicaid points.
• Assist for growing consciousness of the SHIP program, together with examples of when a Medicare enrollee had larger boundaries to care as a result of they came upon about SHIP too late.
• Details about the excessive degree of experience that SHIP applications supply, together with examples of instances when Medicare enrollees couldn’t get points fastened via 1-800 MEDICARE or Medicare.gov, however their SHIP counselor supplied precious help.

2. Limiting Protections In opposition to Stress to Enroll in a Medicare Benefit Plan

Abstract: CMS is enjoyable necessities designed to guard Medicare enrollees from strain to enroll in Medicare plans. Particularly:

• In Part VI.F on web page 58 (entitled “Eradicating Guidelines on time and Method of Beneficiary Outreach”), CMS proposes permitting advertising occasions to happen after instructional occasions in the identical location.
• In Part IV.H on web page 64 (entitled “Third-Occasion Advertising Group Oversight: Revising the Report Retention Necessities for Advertising and Gross sales Name Recordings”), CMS proposes shortening the time a company should retain audio data of calls. CMS’s proposed regulation additionally deletes necessities in 42 C.F.R. 422.2274(g)(2)(ii) and 423.2274(g)(2)(ii) to maintain audio recordings of enrollment calls.

CMS notes that dually eligible people and others who could also be prone to pressuring ways typically come to occasions with a caregiver, which supplies a further layer of safety. CMS additionally notes that there’s a Particular Enrollment Interval for people who got deceptive statements.

Useful areas to remark:

• Opposition to the proposed change. Assist for present guidelines that separate instructional actions from gross sales actions to assist a Medicare enrollee make your best option for themselves with restricted strain to enroll.
• Examples of when people had been pressured into enrolling into Medicare Benefit plans. Some examples might embody instances when people weren’t given correct details about how Medicare Benefit enrollments can jeopardize their retiree protection and dually eligible people who’re bought advantages already accessible to them via Medicaid.
• Tales of how troublesome it’s to entry the Particular Enrollment Interval for people who got deceptive statements when enrolling in a Medicare Benefit plan, and the boundaries to care that enrollees face when attempting to alter plans after deceptive gross sales ways happen.

3. Stress-free Prohibitions on Deceptive, Inaccurate, and Superlative Promoting

Abstract: In Part IV.G on web page 63 (“Stress-free the Restrictions on Language in Promoting”), CMS proposes rest of promoting necessities, together with deletion of a regulatory prohibition on giving inaccurate info, deceptive info, and superlatives.

Useful areas to remark:

• Opposition to the proposed change. Assist for preserving advertising necessities that don’t permit inaccurate info, deceptive info, and superlatives. People who enroll because of these practices can have points accessing providers and suppliers.
• Examples of when people enrolled in a Medicare Benefit plan based mostly on deceptive promoting, and any unfavorable impacts that they skilled consequently.
• Examples could embody instances when enrollees are stunned by the restrictions of supplemental advantages and supplier networks regardless of the commercials touting these advantages and networks.

4. Language and Communication Entry: Notices and Star Rankings Measures

Abstract: People are entitled to free interpreter providers and auxiliary aides when working with Medicare Benefit plans and prescription drug plans. Laws require Medicare Benefit plans and prescription drug plans to supply a “discover of availability” alerting people to their rights to free interpretation providers. In Part IV.I on web page 66 (“Rescinding the Requirement for the Discover of Availability”), CMS proposes deleting the Medicare laws that specify how Medicare Benefit plans and prescription drug plans should present a discover of availability. Whereas all plans will nonetheless be required to supply a discover of availability underneath Part 1557 nondiscrimination laws (45 C.F.R. 92.11(a)), these necessities enforced by the Workplace for Civil Rights will not be as tailor-made to Medicare and don’t require plans to supply the discover in languages past the highest 15 if they’re the first language of no less than 5% of the people within the plan service space. Because of this, some Medicare enrollees could not obtain notices of language entry providers of their language and plans could attempt to present the discover in fewer cases.

In Part V on web page 71 (“Star Rankings”), CMS additionally proposes eradicating high quality metrics measuring whether or not Medicare Benefit Plans are offering entry to international language interpreters and Deaf communication entry (through TTY). CMS states the reasoning behind this transformation is that plans have very excessive efficiency on these metrics and there’s little variation throughout plans.

Useful areas to remark:

• Opposition to the proposed recission. Assist for preserving the requirement for plans to supply a Discover of Availability in all of the required paperwork and languages specified within the Medicare regulation (at 422.2267(e)(31) and 423.2267(e)(33)), because it offers Medicare enrollees clear discover that entry to interpretation is free.
• Assist for high quality metrics that measure whether or not people are supplied with required language interpretation and Deaf communication entry. This can be a core part of high quality and CMS ought to contemplate options to scoring these measures earlier than eradicating them utterly.
• Examples of when people had boundaries to care resulting from lack of entry to interpretation or different communication entry points with the Medicare Benefit plan or Prescription Drug Plan. Examples of how the Discover of Availability helped people get language help providers or auxiliary aides, and the way that help empowers people to handle their well being protection and reduces burden in your group or different community-based organizations with restricted sources.

5. Care Coordination for People Enrolled in a D-SNP and Medicaid Price for Service

Abstract: In Part VI.C on web page 79 (“Continuity in Enrollment for Full-Profit Dually Eligible People in a D-SNP and Medicaid Price-for-Service”), CMS proposes requiring some D-SNPs to have interaction in further care coordination actions and report these actions to CMS. This effort would possible bolster actions to enhance the expertise of dually eligible people who’re in Medicaid charge for service and enrolled in a D-SNP.

Useful areas to remark:

• Assist for bettering the expertise of dually eligible people enrolled in D-SNPs by making certain that D-SNPs are offering care coordination to everybody, together with people who’re in Medicaid fee-for-service (fairly than enrolled in a Medicaid managed care plan). D-SNPs needs to be making certain that each one dually eligible enrollees expertise high-quality integration, which means:
  • Members can entry their Medicare and Medicaid advantages directly;
  • Members have entry to high quality, person-centered care coordination;
  • Built-in service plans embody providers past these sometimes lined by Medicare and Medicaid; and
  • Built-in plans advance rebalancing efforts via nursing facility diversion and transition applications.
• Examples of dually eligible people in Medicaid fee-for-service who would profit from D-SNP help with care coordination (together with help accessing Medicaid providers, submitting Medicaid appeals, accessing transportation, and navigating transitions of care from hospital to house and nursing facility to house).

6. Bettering State Oversight of D-SNPs

Abstract: States are a key associate in monitoring D-SNP actions and appearing to enhance enrollee entry to care. CMS is proposing two modifications that might enhance a state’s capacity to have interaction in D-SNP oversight:

• In Part VI.D on web page 83 (“Contract Modifications for DSNPs Following State Medicaid Company Contract Termination”), CMS proposes to codify a pathway for terminating a D-SNP contract that’s not in compliance with state necessities.
• In Part VI.E on web page 84 (“Limitations on D-SNP-Solely Contracts Submitting Supplies underneath the Multi-Contract Entity Course of”), CMS proposes to require D-SNPs and different entities to submit supplies to a CMS portal in a fashion that permits states to evaluation these supplies.

Useful areas to remark:

• Robust help for these proposed enhancements that permit states to observe the actions of D-SNPs and take motion if D-SNPs will not be offering satisfactory entry to care.
• Examples of the place your state has been useful within the oversight of promoting, enrollee entry to care, and different points.

7. Request for Data: Concern About C-SNPs and I-SNPs

Abstract: In Part VI.F on web page 85 (“C-SNP and I-SNP Progress and Dually Eligible People”), CMS describes a regarding pattern the place dually eligible people seem like enrolling in persistent sickness particular wants plans (C-SNPs) and institutional particular wants plans (I-SNPs). Since C-SNPs and I-SNPs would not have the identical care coordination necessities that D-SNPs do, CMS expressed concern that these enrollees will not be receiving well-integrated care. In a Request for Data, CMS requested for extra info.

Prior to now, CMS has used “D-SNP lookalike guidelines” to stop Medicare Benefit plans from enrolling a excessive variety of dually eligible people with out being topic to heightened integration necessities. D-SNP lookalike guidelines don’t apply to C-SNPs or I-SNPs. CMS is contemplating limiting the variety of dually eligible people enrolled in a C-SNP or I-SNP by increasing “look-alike” guidelines to use to I-SNPs and C-SNPs. For extra info on D-SNP look-alike guidelines, see web page 7 of the Justice in Getting old D-SNP fundamentals transient.

CMS can also be contemplating including extra dually enrolled care coordination necessities for I-SNPs and C-SNPs which have a variety of dually enrolled enrollees.

Useful areas to remark:

• Assist for a system the place a dually eligible particular person who’s enrolled in a C-SNP or I-SNP can entry high-quality integration, together with accessing their Medicaid and Medicare advantages directly, and have entry to high quality person-centered care coordination. This may be completed via heightened necessities for I-SNPs and C-SNPs to have interaction in care coordination and integration. Alternatively, if C-SNPs and I-SNPs will not be offering satisfactory coordination and integration, help for caps on the variety of dually eligible people allowed to enroll in C-SNPs and I-SNPs via an enlargement of D-SNP look-alike guidelines.
• Tales from dually eligible people enrolled in C-SNPs and I-SNPs, together with boundaries to accessing care.
• Any examples of a dually eligible particular person enrolled in a C-SNP or I-SNP underneath questionable circumstances (e.g. strain to enroll, deceptive info, enrolling an individual with out their data, or enrolling an individual with out their consent).

8. Eradicating Discover to Enrollees about Out there Supplemental Advantages

Abstract: Medicare Benefit plans supply many kinds of supplemental advantages, however there are indications that enrollees don’t at all times learn about these advantages or use them. Beginning subsequent 12 months, Medicare Benefit plans had been going to be required to ship a discover to enrollees letting them learn about supplemental advantages that they’re eligible for and haven’t used but. In Part VII.C on web page 94 (“Rescind Mid-12 months Supplemental Advantages Discover”), CMS proposes to now not require such a discover.

Useful areas to remark:

• Opposition to the proposed change. Assist for implementing the mid-year discover of unused supplemental advantages discover, since that discover will alert people to advantages that they will entry.
• Examples of instances when people didn’t perceive what supplemental advantages they could possibly be eligible for.

9. Stopping Public Reviews on Prior Authorization

Abstract: People who enroll in Medicare Benefit expertise excessive charges of prior authorization, which might delay care. In July 2025, Medicare Benefit plans had been going to be required to publish an evaluation of their prior authorization actions, together with knowledge on how prior authorization affected individuals with disabilities and different demographic teams. In June 2025, CMS paused the discharge of those stories. In Part VIII.E on web page 95 (“Rescinding the Annual Well being Fairness Evaluation of Utilization Administration Insurance policies and Procedures”), CMS proposes now not requiring these stories.

Useful areas to remark:

• Opposition to the proposed change. Assist for preserving the requirement to launch prior authorization stories, together with analyses of impacts of prior authorization on totally different communities.
• Examples of how prior authorization has harmed entry to care for people, and the way onerous it’s to see a plan’s observe document with prior authorization practices.

10. Entry to Companies and High quality Enchancment

Abstract: Medicare Benefit plans are required to supply entry to providers, together with entry for (1) individuals of ethnic, cultural, racial, or spiritual minorities; (2) individuals with disabilities; (3) members of the LGBTQI neighborhood; (4) people in rural areas and areas with excessive ranges of deprivation; (5) individuals affected by persistent poverty or inequality; and (6) Folks with restricted English proficiency or studying abilities. In Part VII.D on web page 95 (“Revisions to Guaranteeing Equitable Entry to Medicare Benefit Companies”), CMS proposes deleting references to the above listed teams numbered (1) via (5) when describing a Medicare Benefit plan’s obligation to supply entry to providers. The proposed regulation would learn, “Cultural issues. Be certain that providers are supplied in a culturally competent method to all enrollees, together with these with restricted English proficiency or studying abilities, and numerous cultural and ethnic backgrounds.”

Moreover, Medicare Benefit plans are required to have interaction in high quality enchancment applications. They’re presently required to incorporate actions to cut back disparities in well being and well being care. In Part VII.F at web page 97 (“Rescinding the High quality Enchancment Program Well being Disparities Requirement”), CMS proposes deleting the requirement to incorporate actions to cut back disparities as a part of Medicare Benefit high quality enchancment applications.

Useful areas to remark:

• Opposition to the proposed modifications. Assist for preserving in place in-care entry laws and references to particular teams which have traditionally skilled discrimination in accessing Medicare providers.
• Assist for preserving in place necessities for high quality enchancment actions to incorporate the discount of disparities.
• Tales of how anti-discrimination guidelines and high quality enchancment can defend entry to care for people.

11. Request for Data: Medicare Benefit Plans

Abstract: CMS is in search of info underneath a broad Medicare Benefit Request for Data on tips on how to make Medicare Benefit plans higher. Subjects embody entry to interpretation and translation; necessities round advertising, brokers, and brokers; adequacy of supplier networks; fashions of look after particular wants plans; danger adjustment; high quality enchancment; and entry to vitamin and well-being.

Useful areas for remark:

• Assist for improved entry to high-quality integration, together with safeguarding client selection, enabling entry to unbiased decision-making, and help for improved entry to care and improved expertise.
• Examples when people expertise challenges with commercials, promoting, and interactions with brokers and brokers.
• Examples of how entry to translations and interpreters had been useful in bettering entry to providers.
• Examples of how people expertise boundaries to care, together with challenges associated to being dually eligible for Medicare and Medicaid.
• Examples of boundaries to accessing providers, together with prior authorization and slender supplier networks.
• Examples of how Medicare protection might help handle meals entry, the psychosocial wants of older adults (together with efforts to handle isolation and loneliness), and enhance well being, happiness, and satisfaction in life.