{"abstract":"This proposed rule would implement section 6219 (Adjustments to Medicare Part D Cost-Sharing Reductions for Low-Income Individuals), section 6220 (Requiring Enhanced and Accurate Lists of (REAL) Health Providers Act), and section 6224 (Modernizing and Ensuring Pharmacy Benefit Manager Accountability) of the Consolidated Appropriations Act, 2026.","action":"Proposed 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/2026/10/20/2026-21420.html","cfr_references":[{"chapter":null,"citation_url":null,"part":"422","title":42},{"chapter":null,"citation_url":null,"part":"423","title":42}],"citation":"91 FR 66408","comment_url":"http://www.regulations.gov/commenton/CMS-2026-3533-0002","comments_close_on":"2026-12-15","correction_of":null,"corrections":[],"dates":"To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. Eastern Standard Time on December 15, 2026.","disposition_notes":null,"docket_ids":["CMS-4214-P"],"dockets":[{"supporting_documents":[],"agency_name":"CMS","documents":[{"comment_count":4,"comment_start_date":"2026-10-20","updated_at":"2026-10-27T01:56:31.240-04:00","comment_url":"https://www.regulations.gov/commenton/CMS-2026-3533-0002","allow_late_comments":false,"id":"CMS-2026-3533-0002","comment_end_date":"2026-12-16","regulations_dot_gov_open_for_comment":true}],"supporting_documents_count":0,"id":"CMS-2026-3533","title":"Contract Year 2028 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (CMS-4214-P)"}],"document_number":"2026-21420","effective_on":null,"end_page":66489,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2026/10/20/2026-21420.xml","html_url":"https://www.federalregister.gov/documents/2026/10/20/2026-21420/medicare-program-implementation-of-sections-6219-6220-and-6224-of-the-consolidated-appropriations","images":{"EP20OC26.013":{"large":"https://img.federalregister.gov/EP20OC26.013/EP20OC26.013_large.png","medium":"https://img.federalregister.gov/EP20OC26.013/EP20OC26.013_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.013/EP20OC26.013_original_size.png"},"EP20OC26.012":{"large":"https://img.federalregister.gov/EP20OC26.012/EP20OC26.012_large.png","medium":"https://img.federalregister.gov/EP20OC26.012/EP20OC26.012_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.012/EP20OC26.012_original_size.png"},"EP20OC26.015":{"large":"https://img.federalregister.gov/EP20OC26.015/EP20OC26.015_large.png","medium":"https://img.federalregister.gov/EP20OC26.015/EP20OC26.015_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.015/EP20OC26.015_original_size.png"},"EP20OC26.014":{"large":"https://img.federalregister.gov/EP20OC26.014/EP20OC26.014_large.png","medium":"https://img.federalregister.gov/EP20OC26.014/EP20OC26.014_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.014/EP20OC26.014_original_size.png"},"EP20OC26.011":{"large":"https://img.federalregister.gov/EP20OC26.011/EP20OC26.011_large.png","medium":"https://img.federalregister.gov/EP20OC26.011/EP20OC26.011_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.011/EP20OC26.011_original_size.png"},"EP20OC26.010":{"large":"https://img.federalregister.gov/EP20OC26.010/EP20OC26.010_large.png","medium":"https://img.federalregister.gov/EP20OC26.010/EP20OC26.010_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.010/EP20OC26.010_original_size.png"},"EP20OC26.017":{"large":"https://img.federalregister.gov/EP20OC26.017/EP20OC26.017_large.png","medium":"https://img.federalregister.gov/EP20OC26.017/EP20OC26.017_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.017/EP20OC26.017_original_size.png"},"EP20OC26.016":{"large":"https://img.federalregister.gov/EP20OC26.016/EP20OC26.016_large.png","medium":"https://img.federalregister.gov/EP20OC26.016/EP20OC26.016_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.016/EP20OC26.016_original_size.png"},"EP20OC26.019":{"large":"https://img.federalregister.gov/EP20OC26.019/EP20OC26.019_large.png","medium":"https://img.federalregister.gov/EP20OC26.019/EP20OC26.019_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.019/EP20OC26.019_original_size.png"},"EP20OC26.018":{"large":"https://img.federalregister.gov/EP20OC26.018/EP20OC26.018_large.png","medium":"https://img.federalregister.gov/EP20OC26.018/EP20OC26.018_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.018/EP20OC26.018_original_size.png"},"EP20OC26.002":{"large":"https://img.federalregister.gov/EP20OC26.002/EP20OC26.002_large.png","medium":"https://img.federalregister.gov/EP20OC26.002/EP20OC26.002_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.002/EP20OC26.002_original_size.png"},"EP20OC26.024":{"large":"https://img.federalregister.gov/EP20OC26.024/EP20OC26.024_large.png","medium":"https://img.federalregister.gov/EP20OC26.024/EP20OC26.024_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.024/EP20OC26.024_original_size.png"},"EP20OC26.001":{"large":"https://img.federalregister.gov/EP20OC26.001/EP20OC26.001_large.png","medium":"https://img.federalregister.gov/EP20OC26.001/EP20OC26.001_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.001/EP20OC26.001_original_size.png"},"EP20OC26.023":{"large":"https://img.federalregister.gov/EP20OC26.023/EP20OC26.023_large.png","medium":"https://img.federalregister.gov/EP20OC26.023/EP20OC26.023_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.023/EP20OC26.023_original_size.png"},"EP20OC26.004":{"large":"https://img.federalregister.gov/EP20OC26.004/EP20OC26.004_large.png","medium":"https://img.federalregister.gov/EP20OC26.004/EP20OC26.004_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.004/EP20OC26.004_original_size.png"},"EP20OC26.026":{"large":"https://img.federalregister.gov/EP20OC26.026/EP20OC26.026_large.png","medium":"https://img.federalregister.gov/EP20OC26.026/EP20OC26.026_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.026/EP20OC26.026_original_size.png"},"EP20OC26.003":{"large":"https://img.federalregister.gov/EP20OC26.003/EP20OC26.003_large.png","medium":"https://img.federalregister.gov/EP20OC26.003/EP20OC26.003_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.003/EP20OC26.003_original_size.png"},"EP20OC26.025":{"large":"https://img.federalregister.gov/EP20OC26.025/EP20OC26.025_large.png","medium":"https://img.federalregister.gov/EP20OC26.025/EP20OC26.025_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.025/EP20OC26.025_original_size.png"},"EP20OC26.020":{"large":"https://img.federalregister.gov/EP20OC26.020/EP20OC26.020_large.png","medium":"https://img.federalregister.gov/EP20OC26.020/EP20OC26.020_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.020/EP20OC26.020_original_size.png"},"EP20OC26.000":{"large":"https://img.federalregister.gov/EP20OC26.000/EP20OC26.000_large.png","medium":"https://img.federalregister.gov/EP20OC26.000/EP20OC26.000_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.000/EP20OC26.000_original_size.png"},"EP20OC26.022":{"large":"https://img.federalregister.gov/EP20OC26.022/EP20OC26.022_large.png","medium":"https://img.federalregister.gov/EP20OC26.022/EP20OC26.022_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.022/EP20OC26.022_original_size.png"},"EP20OC26.021":{"large":"https://img.federalregister.gov/EP20OC26.021/EP20OC26.021_large.png","medium":"https://img.federalregister.gov/EP20OC26.021/EP20OC26.021_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.021/EP20OC26.021_original_size.png"},"EP20OC26.009":{"large":"https://img.federalregister.gov/EP20OC26.009/EP20OC26.009_large.png","medium":"https://img.federalregister.gov/EP20OC26.009/EP20OC26.009_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.009/EP20OC26.009_original_size.png"},"EP20OC26.006":{"large":"https://img.federalregister.gov/EP20OC26.006/EP20OC26.006_large.png","medium":"https://img.federalregister.gov/EP20OC26.006/EP20OC26.006_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.006/EP20OC26.006_original_size.png"},"EP20OC26.005":{"large":"https://img.federalregister.gov/EP20OC26.005/EP20OC26.005_large.png","medium":"https://img.federalregister.gov/EP20OC26.005/EP20OC26.005_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.005/EP20OC26.005_original_size.png"},"EP20OC26.027":{"large":"https://img.federalregister.gov/EP20OC26.027/EP20OC26.027_large.png","medium":"https://img.federalregister.gov/EP20OC26.027/EP20OC26.027_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.027/EP20OC26.027_original_size.png"},"EP20OC26.008":{"large":"https://img.federalregister.gov/EP20OC26.008/EP20OC26.008_large.png","medium":"https://img.federalregister.gov/EP20OC26.008/EP20OC26.008_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.008/EP20OC26.008_original_size.png"},"EP20OC26.007":{"large":"https://img.federalregister.gov/EP20OC26.007/EP20OC26.007_large.png","medium":"https://img.federalregister.gov/EP20OC26.007/EP20OC26.007_medium.png","original_size":"https://img.federalregister.gov/EP20OC26.007/EP20OC26.007_original_size.png"}},"images_metadata":{"EP20OC26.013":{"large":{"identifier":"EP20OC26.013","content_type":"image/png","size":13667,"width":822,"sha":"930c17ecbfb02deec27f24d520825ecb","url":"https://img.federalregister.gov/EP20OC26.013/EP20OC26.013_large.png","height":160},"medium":{"identifier":"EP20OC26.013","content_type":"image/png","size":6615,"width":539,"sha":"1fc601a399fbd075603899837d905aed","url":"https://img.federalregister.gov/EP20OC26.013/EP20OC26.013_medium.png","height":105},"original_size":{"identifier":"EP20OC26.013","content_type":"image/png","size":11019,"width":2039,"sha":"362044f85fda881427c00923fb5cc131","url":"https://img.federalregister.gov/EP20OC26.013/EP20OC26.013_original_size.png","height":397}},"EP20OC26.012":{"large":{"identifier":"EP20OC26.012","content_type":"image/png","size":16193,"width":823,"sha":"6e807fba8a31b7ad17d9aedca4d8cd12","url":"https://img.federalregister.gov/EP20OC26.012/EP20OC26.012_large.png","height":193},"medium":{"identifier":"EP20OC26.012","content_type":"image/png","size":6588,"width":512,"sha":"78c35231e6eb5d202baf5bd3201796e4","url":"https://img.federalregister.gov/EP20OC26.012/EP20OC26.012_medium.png","height":120},"original_size":{"identifier":"EP20OC26.012","content_type":"image/png","size":11080,"width":1942,"sha":"65b0fe1c0663e60a4a115eb7997151f0","url":"https://img.federalregister.gov/EP20OC26.012/EP20OC26.012_original_size.png","height":455}},"EP20OC26.015":{"large":{"identifier":"EP20OC26.015","content_type":"image/png","size":13163,"width":823,"sha":"de69c5748daf59b96f4d8864b11231e4","url":"https://img.federalregister.gov/EP20OC26.015/EP20OC26.015_large.png","height":162},"medium":{"identifier":"EP20OC26.015","content_type":"image/png","size":5932,"width":534,"sha":"83bdd973022288c861f176d5babc615e","url":"https://img.federalregister.gov/EP20OC26.015/EP20OC26.015_medium.png","height":105},"original_size":{"identifier":"EP20OC26.015","content_type":"image/png","size":9925,"width":2018,"sha":"6e7ee4bc5f247b608464c6d210b21be0","url":"https://img.federalregister.gov/EP20OC26.015/EP20OC26.015_original_size.png","height":397}},"EP20OC26.014":{"large":{"identifier":"EP20OC26.014","content_type":"image/png","size":11326,"width":823,"sha":"e542206ed887fec8b379fc8aac595884","url":"https://img.federalregister.gov/EP20OC26.014/EP20OC26.014_large.png","height":139},"medium":{"identifier":"EP20OC26.014","content_type":"image/png","size":6053,"width":562,"sha":"a9158940ac248b7f5abdff922371cbe9","url":"https://img.federalregister.gov/EP20OC26.014/EP20OC26.014_medium.png","height":95},"original_size":{"identifier":"EP20OC26.014","content_type":"image/png","size":10107,"width":2121,"sha":"d6555e12e5061ca568ab2ad8b0851901","url":"https://img.federalregister.gov/EP20OC26.014/EP20OC26.014_original_size.png","height":358}},"EP20OC26.011":{"large":{"identifier":"EP20OC26.011","content_type":"image/png","size":10506,"width":823,"sha":"b5166ddac1de30644b7212d4d69cddb2","url":"https://img.federalregister.gov/EP20OC26.011/EP20OC26.011_large.png","height":126},"medium":{"identifier":"EP20OC26.011","content_type":"image/png","size":6260,"width":573,"sha":"0f7635b2f777aa2f9c97de098b43955e","url":"https://img.federalregister.gov/EP20OC26.011/EP20OC26.011_medium.png","height":88},"original_size":{"identifier":"EP20OC26.011","content_type":"image/png","size":10321,"width":2167,"sha":"375624ba7d9483c9bdbc5eaef5280669","url":"https://img.federalregister.gov/EP20OC26.011/EP20OC26.011_original_size.png","height":333}},"EP20OC26.010":{"large":{"identifier":"EP20OC26.010","content_type":"image/png","size":11444,"width":823,"sha":"6314eb2a21b9e0092a21a97f9d62bfd2","url":"https://img.federalregister.gov/EP20OC26.010/EP20OC26.010_large.png","height":145},"medium":{"identifier":"EP20OC26.010","content_type":"image/png","size":5094,"width":480,"sha":"2f60bec7e436513002c3845f9a92c644","url":"https://img.federalregister.gov/EP20OC26.010/EP20OC26.010_medium.png","height":85},"original_size":{"identifier":"EP20OC26.010","content_type":"image/png","size":7746,"width":1811,"sha":"0d49b28ca2586570bfcc5e3f36c2af84","url":"https://img.federalregister.gov/EP20OC26.010/EP20OC26.010_original_size.png","height":320}},"EP20OC26.017":{"large":{"identifier":"EP20OC26.017","content_type":"image/png","size":9951,"width":819,"sha":"c546a69110f850876b9d6c88692fdb7d","url":"https://img.federalregister.gov/EP20OC26.017/EP20OC26.017_large.png","height":119},"medium":{"identifier":"EP20OC26.017","content_type":"image/png","size":4624,"width":480,"sha":"51c85626a9e3e962217abee7653ec32b","url":"https://img.federalregister.gov/EP20OC26.017/EP20OC26.017_medium.png","height":70},"original_size":{"identifier":"EP20OC26.017","content_type":"image/png","size":7771,"width":1811,"sha":"53797b54c190c49e6dad51e3e3a3b969","url":"https://img.federalregister.gov/EP20OC26.017/EP20OC26.017_original_size.png","height":263}},"EP20OC26.016":{"large":{"identifier":"EP20OC26.016","content_type":"image/png","size":14071,"width":822,"sha":"f58cd4137c38b7f866410c7d1b25cab2","url":"https://img.federalregister.gov/EP20OC26.016/EP20OC26.016_large.png","height":147},"medium":{"identifier":"EP20OC26.016","content_type":"image/png","size":5992,"width":530,"sha":"7767b9bf0728c37427bafc8b01e4fdd5","url":"https://img.federalregister.gov/EP20OC26.016/EP20OC26.016_medium.png","height":95},"original_size":{"identifier":"EP20OC26.016","content_type":"image/png","size":9609,"width":2001,"sha":"13ef0010586532f496a98749931d66f5","url":"https://img.federalregister.gov/EP20OC26.016/EP20OC26.016_original_size.png","height":358}},"EP20OC26.019":{"large":{"identifier":"EP20OC26.019","content_type":"image/png","size":11566,"width":817,"sha":"bbf5ff2da6ed26a8c27d25f367f20ac4","url":"https://img.federalregister.gov/EP20OC26.019/EP20OC26.019_large.png","height":137},"medium":{"identifier":"EP20OC26.019","content_type":"image/png","size":4829,"width":476,"sha":"1a64ec4892b0f2d953374cae3a80df34","url":"https://img.federalregister.gov/EP20OC26.019/EP20OC26.019_medium.png","height":80},"original_size":{"identifier":"EP20OC26.019","content_type":"image/png","size":7918,"width":1795,"sha":"190143901ade767d76cbfcf271dd3fce","url":"https://img.federalregister.gov/EP20OC26.019/EP20OC26.019_original_size.png","height":301}},"EP20OC26.018":{"large":{"identifier":"EP20OC26.018","content_type":"image/png","size":11202,"width":823,"sha":"cf908499eb59175cdcb16da6889f46b7","url":"https://img.federalregister.gov/EP20OC26.018/EP20OC26.018_large.png","height":143},"medium":{"identifier":"EP20OC26.018","content_type":"image/png","size":5984,"width":489,"sha":"ee7703b6f512719621134f94bb374b0a","url":"https://img.federalregister.gov/EP20OC26.018/EP20OC26.018_medium.png","height":85},"original_size":{"identifier":"EP20OC26.018","content_type":"image/png","size":9122,"width":1847,"sha":"706f49b2352f9eef8a59648dbc7075ca","url":"https://img.federalregister.gov/EP20OC26.018/EP20OC26.018_original_size.png","height":320}},"EP20OC26.002":{"large":{"identifier":"EP20OC26.002","content_type":"image/png","size":21363,"width":823,"sha":"cf8da437608f4492122d6f0d8d5eed1d","url":"https://img.federalregister.gov/EP20OC26.002/EP20OC26.002_large.png","height":208},"medium":{"identifier":"EP20OC26.002","content_type":"image/png","size":12421,"width":574,"sha":"aea65056f58f9b4acee65d193d0a9432","url":"https://img.federalregister.gov/EP20OC26.002/EP20OC26.002_medium.png","height":145},"original_size":{"identifier":"EP20OC26.002","content_type":"image/png","size":19710,"width":2167,"sha":"6dd2b35986f5c5a2fad1b27c2fa88681","url":"https://img.federalregister.gov/EP20OC26.002/EP20OC26.002_original_size.png","height":548}},"EP20OC26.024":{"large":{"identifier":"EP20OC26.024","content_type":"image/png","size":15920,"width":823,"sha":"47168b073ea78c1f8a682689a1830acb","url":"https://img.federalregister.gov/EP20OC26.024/EP20OC26.024_large.png","height":180},"medium":{"identifier":"EP20OC26.024","content_type":"image/png","size":9159,"width":574,"sha":"2d85f0d59db47da27f5d05e9557495d5","url":"https://img.federalregister.gov/EP20OC26.024/EP20OC26.024_medium.png","height":126},"original_size":{"identifier":"EP20OC26.024","content_type":"image/png","size":15322,"width":2167,"sha":"0c043f32072ae8a79a57747df299e0de","url":"https://img.federalregister.gov/EP20OC26.024/EP20OC26.024_original_size.png","height":474}},"EP20OC26.001":{"large":{"identifier":"EP20OC26.001","content_type":"image/png","size":31354,"width":823,"sha":"1302ad72025898072e5da7c9d7f8776c","url":"https://img.federalregister.gov/EP20OC26.001/EP20OC26.001_large.png","height":374},"medium":{"identifier":"EP20OC26.001","content_type":"image/png","size":13653,"width":515,"sha":"6854122b0165dc7969d89b9862c7eba6","url":"https://img.federalregister.gov/EP20OC26.001/EP20OC26.001_medium.png","height":234},"original_size":{"identifier":"EP20OC26.001","content_type":"image/png","size":54179,"width":1947,"sha":"5bffd188e473f7e198cea311f83ba3c4","url":"https://img.federalregister.gov/EP20OC26.001/EP20OC26.001_original_size.png","height":885}},"EP20OC26.023":{"large":{"identifier":"EP20OC26.023","content_type":"image/png","size":38972,"width":823,"sha":"545d6353cad43440fb2ffe52b8132066","url":"https://img.federalregister.gov/EP20OC26.023/EP20OC26.023_large.png","height":395},"medium":{"identifier":"EP20OC26.023","content_type":"image/png","size":23519,"width":574,"sha":"a1ea44fdac2d38866f5892cdaa7a9477","url":"https://img.federalregister.gov/EP20OC26.023/EP20OC26.023_medium.png","height":276},"original_size":{"identifier":"EP20OC26.023","content_type":"image/png","size":30756,"width":2167,"sha":"558a196c8eccaef14e7d9914c9606656","url":"https://img.federalregister.gov/EP20OC26.023/EP20OC26.023_original_size.png","height":1041}},"EP20OC26.004":{"large":{"identifier":"EP20OC26.004","content_type":"image/png","size":39388,"width":821,"sha":"b4c0a42413bf65f4b42e1869f38d7065","url":"https://img.federalregister.gov/EP20OC26.004/EP20OC26.004_large.png","height":389},"medium":{"identifier":"EP20OC26.004","content_type":"image/png","size":19751,"width":574,"sha":"81adc1c85e9eb19e935bd6e188c5717f","url":"https://img.federalregister.gov/EP20OC26.004/EP20OC26.004_medium.png","height":272},"original_size":{"identifier":"EP20OC26.004","content_type":"image/png","size":29394,"width":2167,"sha":"7605ee735b70c38a894b79a3d94df3cb","url":"https://img.federalregister.gov/EP20OC26.004/EP20OC26.004_original_size.png","height":1027}},"EP20OC26.026":{"large":{"identifier":"EP20OC26.026","content_type":"image/png","size":8423,"width":817,"sha":"f61206a102bb8e380f9b7a9504ff4d1b","url":"https://img.federalregister.gov/EP20OC26.026/EP20OC26.026_large.png","height":63},"medium":{"identifier":"EP20OC26.026","content_type":"image/png","size":4672,"width":571,"sha":"f10da92d098d99df7b18fb2b382a96b8","url":"https://img.federalregister.gov/EP20OC26.026/EP20OC26.026_medium.png","height":44},"original_size":{"identifier":"EP20OC26.026","content_type":"image/png","size":8193,"width":2167,"sha":"fcf8b165deeba032e62f1bd85b12f70e","url":"https://img.federalregister.gov/EP20OC26.026/EP20OC26.026_original_size.png","height":167}},"EP20OC26.003":{"large":{"identifier":"EP20OC26.003","content_type":"image/png","size":18531,"width":820,"sha":"d1d5f182ff27459975a12832b03a0973","url":"https://img.federalregister.gov/EP20OC26.003/EP20OC26.003_large.png","height":174},"medium":{"identifier":"EP20OC26.003","content_type":"image/png","size":10756,"width":570,"sha":"43fc830ee77b463e0c5ad75fc49e93bc","url":"https://img.federalregister.gov/EP20OC26.003/EP20OC26.003_medium.png","height":121},"original_size":{"identifier":"EP20OC26.003","content_type":"image/png","size":18250,"width":2167,"sha":"5b4af994dad68c3dec1425acd8a97c5f","url":"https://img.federalregister.gov/EP20OC26.003/EP20OC26.003_original_size.png","height":460}},"EP20OC26.025":{"large":{"identifier":"EP20OC26.025","content_type":"image/png","size":7350,"width":820,"sha":"8737dd771a16234625170ecf568b7faf","url":"https://img.federalregister.gov/EP20OC26.025/EP20OC26.025_large.png","height":188},"medium":{"identifier":"EP20OC26.025","content_type":"image/png","size":3805,"width":571,"sha":"7d033d6fa01a77f53cd96e66af142033","url":"https://img.federalregister.gov/EP20OC26.025/EP20OC26.025_medium.png","height":131},"original_size":{"identifier":"EP20OC26.025","content_type":"image/png","size":3990,"width":2167,"sha":"0003028ca5d81a3dbef3b827f499ec33","url":"https://img.federalregister.gov/EP20OC26.025/EP20OC26.025_original_size.png","height":497}},"EP20OC26.020":{"large":{"identifier":"EP20OC26.020","content_type":"image/png","size":11741,"width":818,"sha":"6ea6072db32652a404190be5ff9d671f","url":"https://img.federalregister.gov/EP20OC26.020/EP20OC26.020_large.png","height":136},"medium":{"identifier":"EP20OC26.020","content_type":"image/png","size":5194,"width":475,"sha":"dad875a383f1c7924304558e6c816d31","url":"https://img.federalregister.gov/EP20OC26.020/EP20OC26.020_medium.png","height":79},"original_size":{"identifier":"EP20OC26.020","content_type":"image/png","size":8215,"width":1811,"sha":"480224902abf3fac49aff56b70538755","url":"https://img.federalregister.gov/EP20OC26.020/EP20OC26.020_original_size.png","height":301}},"EP20OC26.000":{"large":{"identifier":"EP20OC26.000","content_type":"image/png","size":32277,"width":823,"sha":"b26eb8781f2733bf8f603244f0ee52f1","url":"https://img.federalregister.gov/EP20OC26.000/EP20OC26.000_large.png","height":296},"medium":{"identifier":"EP20OC26.000","content_type":"image/png","size":17763,"width":567,"sha":"8814cda9676cb1643feb11cc387c88b4","url":"https://img.federalregister.gov/EP20OC26.000/EP20OC26.000_medium.png","height":204},"original_size":{"identifier":"EP20OC26.000","content_type":"image/png","size":32133,"width":2146,"sha":"b33ee92328f864610f9a96a6670ec701","url":"https://img.federalregister.gov/EP20OC26.000/EP20OC26.000_original_size.png","height":772}},"EP20OC26.022":{"large":{"identifier":"EP20OC26.022","content_type":"image/png","size":34964,"width":822,"sha":"70f4c87097bf04869ec10cdbd68ef29d","url":"https://img.federalregister.gov/EP20OC26.022/EP20OC26.022_large.png","height":361},"medium":{"identifier":"EP20OC26.022","content_type":"image/png","size":19171,"width":574,"sha":"b2cec7cdcc87b568430d815183d2a2b9","url":"https://img.federalregister.gov/EP20OC26.022/EP20OC26.022_medium.png","height":252},"original_size":{"identifier":"EP20OC26.022","content_type":"image/png","size":31606,"width":2167,"sha":"d417b71ebb3bbed65417ee49e8d0c62e","url":"https://img.federalregister.gov/EP20OC26.022/EP20OC26.022_original_size.png","height":952}},"EP20OC26.021":{"large":{"identifier":"EP20OC26.021","content_type":"image/png","size":11435,"width":818,"sha":"60d6ca966824c5c09046f7c98cdd0e27","url":"https://img.federalregister.gov/EP20OC26.021/EP20OC26.021_large.png","height":136},"medium":{"identifier":"EP20OC26.021","content_type":"image/png","size":5015,"width":475,"sha":"3f1e7d20cee90121b7a7d5268ed2052b","url":"https://img.federalregister.gov/EP20OC26.021/EP20OC26.021_medium.png","height":79},"original_size":{"identifier":"EP20OC26.021","content_type":"image/png","size":7828,"width":1811,"sha":"70e15afd112e7f30601e6f69f1f27da5","url":"https://img.federalregister.gov/EP20OC26.021/EP20OC26.021_original_size.png","height":301}},"EP20OC26.009":{"large":{"identifier":"EP20OC26.009","content_type":"image/png","size":12622,"width":822,"sha":"676f4d4d260849788f57dc01d9be288d","url":"https://img.federalregister.gov/EP20OC26.009/EP20OC26.009_large.png","height":159},"medium":{"identifier":"EP20OC26.009","content_type":"image/png","size":5628,"width":490,"sha":"9ea32c8bf3792722370bbb84cf87131c","url":"https://img.federalregister.gov/EP20OC26.009/EP20OC26.009_medium.png","height":95},"original_size":{"identifier":"EP20OC26.009","content_type":"image/png","size":9248,"width":1850,"sha":"ac02d67e5cf816e283ee01a9e3b71dc1","url":"https://img.federalregister.gov/EP20OC26.009/EP20OC26.009_original_size.png","height":358}},"EP20OC26.006":{"large":{"identifier":"EP20OC26.006","content_type":"image/png","size":22834,"width":822,"sha":"8782d0a2c10913a6fe049b32d7c3b183","url":"https://img.federalregister.gov/EP20OC26.006/EP20OC26.006_large.png","height":247},"medium":{"identifier":"EP20OC26.006","content_type":"image/png","size":11456,"width":573,"sha":"e9e01cfbf13a0468018a7ad6eb0b3597","url":"https://img.federalregister.gov/EP20OC26.006/EP20OC26.006_medium.png","height":172},"original_size":{"identifier":"EP20OC26.006","content_type":"image/png","size":18321,"width":2167,"sha":"f6bcdd61d06558cf741582b9650f13a6","url":"https://img.federalregister.gov/EP20OC26.006/EP20OC26.006_original_size.png","height":651}},"EP20OC26.005":{"large":{"identifier":"EP20OC26.005","content_type":"image/png","size":17771,"width":822,"sha":"cb9d088182061d873e3ed7e82c1d762d","url":"https://img.federalregister.gov/EP20OC26.005/EP20OC26.005_large.png","height":231},"medium":{"identifier":"EP20OC26.005","content_type":"image/png","size":7764,"width":477,"sha":"70a036b1b83eca5437d50c1aeb4eeaee","url":"https://img.federalregister.gov/EP20OC26.005/EP20OC26.005_medium.png","height":134},"original_size":{"identifier":"EP20OC26.005","content_type":"image/png","size":13280,"width":1798,"sha":"18872463d401a62f76d2460f437b7449","url":"https://img.federalregister.gov/EP20OC26.005/EP20OC26.005_original_size.png","height":505}},"EP20OC26.027":{"large":{"identifier":"EP20OC26.027","content_type":"image/png","size":16128,"width":823,"sha":"d410266bf7adf40ffa7bf0c77bec9ffc","url":"https://img.federalregister.gov/EP20OC26.027/EP20OC26.027_large.png","height":190},"medium":{"identifier":"EP20OC26.027","content_type":"image/png","size":8940,"width":532,"sha":"f1570e835e3b059dd4d0d9b688e9b6b1","url":"https://img.federalregister.gov/EP20OC26.027/EP20OC26.027_medium.png","height":123},"original_size":{"identifier":"EP20OC26.027","content_type":"image/png","size":13910,"width":2008,"sha":"b0e61926befc6e002446174a5c27f38d","url":"https://img.federalregister.gov/EP20OC26.027/EP20OC26.027_original_size.png","height":463}},"EP20OC26.008":{"large":{"identifier":"EP20OC26.008","content_type":"image/png","size":30808,"width":822,"sha":"4f6962684cb46a26dde6e25bf68bd655","url":"https://img.federalregister.gov/EP20OC26.008/EP20OC26.008_large.png","height":357},"medium":{"identifier":"EP20OC26.008","content_type":"image/png","size":15758,"width":536,"sha":"5f1b87b2a184bf1e22d4e0455fbf0dc0","url":"https://img.federalregister.gov/EP20OC26.008/EP20OC26.008_medium.png","height":233},"original_size":{"identifier":"EP20OC26.008","content_type":"image/png","size":26765,"width":2028,"sha":"980fa7184b46f91de61213175d7f869c","url":"https://img.federalregister.gov/EP20OC26.008/EP20OC26.008_original_size.png","height":881}},"EP20OC26.007":{"large":{"identifier":"EP20OC26.007","content_type":"image/png","size":22324,"width":823,"sha":"3a4e3d462026c702ccb21156275cf57e","url":"https://img.federalregister.gov/EP20OC26.007/EP20OC26.007_large.png","height":254},"medium":{"identifier":"EP20OC26.007","content_type":"image/png","size":13155,"width":574,"sha":"5dfdc9bd85bac24cc2f5f4ef13b9ef19","url":"https://img.federalregister.gov/EP20OC26.007/EP20OC26.007_medium.png","height":177},"original_size":{"identifier":"EP20OC26.007","content_type":"image/png","size":18362,"width":2167,"sha":"991d8b25fa6ca4c5e80f2a92e8e36f0e","url":"https://img.federalregister.gov/EP20OC26.007/EP20OC26.007_original_size.png","height":669}}},"json_url":"https://www.federalregister.gov/api/v1/documents/2026-21420?publication_date=2026-10-20","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2026-10-20/2026-21420/mods.xml","not_received_for_publication":null,"page_length":82,"page_views":{"count":2696,"last_updated":"2026-10-27 16:15:05 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-10-20/pdf/2026-21420.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-21420.pdf?1792181710","publication_date":"2026-10-20","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2026/10/20/2026-21420.txt","regulation_id_number_info":{"0938-AV88":null},"regulation_id_numbers":["0938-AV88"],"regulations_dot_gov_info":{"supporting_documents":[],"comments_count":4,"agency_id":"CMS","comments_url":"https://www.regulations.gov/docketBrowser?rpp=50&so=DESC&sb=postedDate&po=0&dct=PS&D=CMS-2026-3533","supporting_documents_count":0,"docket_id":"CMS-2026-3533","document_id":"CMS-2026-3533-0002","regulation_id_number":"0938-AV88","title":"Contract Year 2028 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (CMS-4214-P)","checked_regulationsdotgov_at":"2026-10-27T20:55:04Z"},"regulations_dot_gov_url":"http://www.regulations.gov/commenton/CMS-2026-3533-0002","significant":null,"signing_date":null,"start_page":66408,"subtype":null,"title":"Medicare Program; Implementation of Sections 6219, 6220, and 6224 of the Consolidated Appropriations Act, 2026","toc_doc":"Implementation of Sections 6219, 6220, and 6224 of the Consolidated Appropriations Act, 2026","toc_subject":"Medicare Program","topics":["Administrative practice and procedure","Health facilities","Health maintenance organizations (HMO)","Medicare","Penalties","Privacy","Reporting and recordkeeping requirements"],"type":"Proposed Rule","volume":91}