{"abstract":"This final rule will revise the Medicare Advantage (MA) program (Part C) regulations and Prescription Drug Benefit program (Part D) regulations to implement certain provisions of the Bipartisan Budget Act of 2018; improve quality and accessibility; clarify certain program integrity policies for MA, Part D, and cost plans and PACE organizations; reduce burden on providers, MA plans, and Part D sponsors through providing additional policy clarification; and implement other technical changes regarding quality improvement. This final rule will also revise the appeals and grievances requirements for certain Medicaid managed care and MA special needs plans for dual eligible individuals to implement certain provisions of the Bipartisan Budget Act of 2018.","action":"Final rule.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2019/04/16/2019-06822.html","cfr_references":[{"chapter":null,"citation_url":null,"part":422,"title":42},{"chapter":null,"citation_url":null,"part":423,"title":42},{"chapter":null,"citation_url":null,"part":438,"title":42},{"chapter":null,"citation_url":null,"part":498,"title":42}],"citation":"84 FR 15680","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"Effective Dates: These regulations are effective on January 1, 2020, except for the amendments to Sec. Sec. 422.107(c)(9), (d), (e)(2), 422.560(a)(4) and (b)(5), 422.566(a), 422.629 through 422.634, 422.752(d), 438.210, 438.400, and 438.402, which are effective January 1, 2021, and for the amendments to Sec. Sec. 422.222(a)(2), 423.120(c)(6)(iv), and 498.5(n)(1), which are effective June 17, 2019.","disposition_notes":null,"docket_ids":["CMS-4185-F"],"dockets":[],"document_number":"2019-06822","effective_on":"2020-01-01","end_page":15844,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2019/04/16/2019-06822.xml","html_url":"https://www.federalregister.gov/documents/2019/04/16/2019-06822/medicare-and-medicaid-programs-policy-and-technical-changes-to-the-medicare-advantage-medicare","images":{"ER16AP19.005":{"large":"https://img.federalregister.gov/ER16AP19.005/ER16AP19.005_large.png","original_size":"https://img.federalregister.gov/ER16AP19.005/ER16AP19.005_original_size.png"},"ER16AP19.003":{"large":"https://img.federalregister.gov/ER16AP19.003/ER16AP19.003_large.png","original_size":"https://img.federalregister.gov/ER16AP19.003/ER16AP19.003_original_size.png"},"ER16AP19.004":{"large":"https://img.federalregister.gov/ER16AP19.004/ER16AP19.004_large.png","original_size":"https://img.federalregister.gov/ER16AP19.004/ER16AP19.004_original_size.png"},"ER16AP19.001":{"large":"https://img.federalregister.gov/ER16AP19.001/ER16AP19.001_large.png","original_size":"https://img.federalregister.gov/ER16AP19.001/ER16AP19.001_original_size.png"},"ER16AP19.002":{"large":"https://img.federalregister.gov/ER16AP19.002/ER16AP19.002_large.png","original_size":"https://img.federalregister.gov/ER16AP19.002/ER16AP19.002_original_size.png"},"ER16AP19.000":{"large":"https://img.federalregister.gov/ER16AP19.000/ER16AP19.000_large.png","original_size":"https://img.federalregister.gov/ER16AP19.000/ER16AP19.000_original_size.png"}},"images_metadata":{"ER16AP19.005":{"large":{"identifier":"ER16AP19.005","content_type":"image/png","size":70093,"width":497,"sha":"2388123f230728fb67d948f7f13041d7","url":"https://img.federalregister.gov/ER16AP19.005/ER16AP19.005_large.png","height":1400},"original_size":{"identifier":"ER16AP19.005","content_type":"image/png","size":66102,"width":1767,"sha":"e32504edaccd5af4efd2387e259316aa","url":"https://img.federalregister.gov/ER16AP19.005/ER16AP19.005_original_size.png","height":4979}},"ER16AP19.003":{"large":{"identifier":"ER16AP19.003","content_type":"image/png","size":55657,"width":337,"sha":"1e9c2f9d422191c506ec7f75652a39b4","url":"https://img.federalregister.gov/ER16AP19.003/ER16AP19.003_large.png","height":1385},"original_size":{"identifier":"ER16AP19.003","content_type":"image/png","size":67102,"width":1197,"sha":"b80c26cc56d49d378791a9764624e6b3","url":"https://img.federalregister.gov/ER16AP19.003/ER16AP19.003_original_size.png","height":4919}},"ER16AP19.004":{"large":{"identifier":"ER16AP19.004","content_type":"image/png","size":139458,"width":823,"sha":"e8e079a0bfc3824d8195cfd9f97e845f","url":"https://img.federalregister.gov/ER16AP19.004/ER16AP19.004_large.png","height":1330},"original_size":{"identifier":"ER16AP19.004","content_type":"image/png","size":126233,"width":3299,"sha":"f72ae25e2b3e8f13233087772d14853e","url":"https://img.federalregister.gov/ER16AP19.004/ER16AP19.004_original_size.png","height":5333}},"ER16AP19.001":{"large":{"identifier":"ER16AP19.001","content_type":"image/png","size":103276,"width":610,"sha":"9cfdfc2079f2674644535e1b29002d41","url":"https://img.federalregister.gov/ER16AP19.001/ER16AP19.001_large.png","height":1456},"original_size":{"identifier":"ER16AP19.001","content_type":"image/png","size":116018,"width":2171,"sha":"670b246acc9da29fe01f8ac7816b567c","url":"https://img.federalregister.gov/ER16AP19.001/ER16AP19.001_original_size.png","height":5178}},"ER16AP19.002":{"large":{"identifier":"ER16AP19.002","content_type":"image/png","size":147624,"width":823,"sha":"a7024e089c946f9e5e416303eb69aec8","url":"https://img.federalregister.gov/ER16AP19.002/ER16AP19.002_large.png","height":1282},"original_size":{"identifier":"ER16AP19.002","content_type":"image/png","size":261084,"width":3422,"sha":"d2e69b76b5d0b3adc36d7d05ff19470c","url":"https://img.federalregister.gov/ER16AP19.002/ER16AP19.002_original_size.png","height":5333}},"ER16AP19.000":{"large":{"identifier":"ER16AP19.000","content_type":"image/png","size":23774,"width":823,"sha":"488eb2d0c273b040e9daa4a9ddbbf9ee","url":"https://img.federalregister.gov/ER16AP19.000/ER16AP19.000_large.png","height":207},"original_size":{"identifier":"ER16AP19.000","content_type":"image/png","size":50189,"width":4319,"sha":"322ea0379288b8e1c561a5fe127e86bc","url":"https://img.federalregister.gov/ER16AP19.000/ER16AP19.000_original_size.png","height":1086}}},"json_url":"https://www.federalregister.gov/api/v1/documents/2019-06822?publication_date=2019-04-16","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2019-04-16/2019-06822/mods.xml","not_received_for_publication":null,"page_length":165,"page_views":{"count":25311,"last_updated":"2026-07-28 06:15:03 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2019-04-16/pdf/2019-06822.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2019-06822.pdf?1554495321","publication_date":"2019-04-16","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2019/04/16/2019-06822.txt","regulation_id_number_info":{"0938-AT59":{"issue":"202210","html_url":"https://www.federalregister.gov/regulations/0938-AT59/policy-and-technical-changes-to-the-medicare-advantage-and-the-medicare-prescription-drug-benefit-pr","title":"Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs for Contract Year 2020; Risk Adjustment Data Validation (CMS-4185)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=202210&RIN=0938-AT59&operation=OPERATION_EXPORT_XML","priority_category":"Economically Significant"}},"regulation_id_numbers":["0938-AT59"],"regulations_dot_gov_info":{"checked_regulationsdotgov_at":"2019-05-24T16:51:05Z"},"regulations_dot_gov_url":null,"significant":true,"signing_date":null,"start_page":15680,"subtype":null,"title":"Medicare and Medicaid Programs; Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Programs of All-Inclusive Care for the Elderly (PACE), Medicaid Fee-For-Service, and Medicaid Managed Care Programs for Years 2020 and 2021","toc_doc":"Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, etc.","toc_subject":"Medicare and Medicaid Programs:","topics":["Administrative practice and procedure","Emergency medical services","Grant programs-health","Health facilities","Health maintenance organizations (HMO)","Health professions","Medicaid","Medicare","Penalties","Privacy","Reporting and recordkeeping requirements"],"type":"Rule","volume":84}