On November 22, 2010, CMS is publishing a proposed rule that would update Medicare Advantage (MA) and Part D prescription drug benefit regulations to reflect ACA requirements and make other program changes for contract year 2012. Specifically, the proposed rule would implement ACA provisions that, among other things: limit beneficiary cost sharing for certain services under MA plans; clarify the Secretary’s authority to deny certain MA and Part D plan bids; permit MA and Part D plans to waive a de minimis monthly beneficiary premium for low income subsidy (LIS) eligible enrollees and make related changes to LIS reassignment rules; provide for an income-related increase in Part D monthly premiums; eliminate Part D cost-sharing for full-benefit dual eligible individuals who are receiving certain home and community-based services; codify statutory changes to close the Part D coverage gap (sometimes referred to as the “donut hole”); update the methodology for using quality ratings to determine MA bonus payments; and provide for more frequent dispensing of certain branded drugs for Part D beneficiaries residing in long term care facilities to reduce waste. In addition to these ACA provisions, the rule would clarify program requirements to: prevent certain Part D and MA executives whose plans are barred from participation from serving in similar capacities in other plans; establish new standards regarding MA plan employment of personnel to make certain medical policy determinations; strengthen various beneficiary protection provisions; establish training requirements for MA and Part D sponsor agents and brokers; and establish plan fiscal solvency standards. CMS will accept comments for 60 days after publication. In a related development, CMS has posted the 2011 Medicare Plan Star Ratings and announced a 3-year demonstration to provide MA plans with financial incentives to provide high-quality care.