CMS proposes Medicare Advantage directory-accuracy, PBM-compensation and low-income cost-sharing rules (CMS-4214-P)

What changed

CMS proposed rules implementing three provisions Congress enacted in the Consolidated Appropriations Act, 2026 (Pub. L. 119-75, enacted February 3, 2026). The proposal implements a statute; CMS's discretion is mainly over methods (sampling, grading, fair-market value).

• Directories (§6220), from plan year 2028:
  • MA plans would verify provider directory information at least every 90 days. Hospitals and other designated facilities: at least every 12 months.
  • Unverifiable providers would be flagged.
  • Plans would run an annual accuracy analysis and report a score to CMS. From contract year 2029, plans would display it in the directory as a letter grade ("Information Accuracy"), and CMS would publish scores in machine-readable form.
  • CMS is only considering, and seeking comment on, a requirement that an independent third party certify the analysis.
  • An enrollee who relies on an inaccurate directory and receives out-of-network care would pay no more than in-network cost sharing.
• PBMs (§6224), from 2028: Part D sponsors, both stand-alone and MA-PD, would have to limit PBM pay to flat-dollar, fair-market-value "bona fide service fees". These fees could not be tied to drug price, rebates or formulary placement. The proposal adds reporting and disgorgement duties.
• Low-income cost sharing (§6219): the generic copay for full-benefit dual-eligible enrollees at or below 100% of the federal poverty level falls from $1 to $0, plan years beginning on or after January 1, 2028.

What this establishes

The statutory requirements and CMS's proposed method of implementing them.

What this does not establish

• No beneficiary protection is in effect today. The directory protections begin no earlier than plan year 2028.
• Not every directory error creates liability.
• The PBM terms are not final.
• CMS itself says the PBM financial impact "is not able to be estimated".

Why it matters

A directory is how a plan represents its network. Under this rule, an inaccurate directory becomes a measurable, graded and partly cost-bearing failure. The work of keeping directories accurate runs through credentialing offices and physician practices.

Next decision point

Comments close December 15, 2026. CMS says a separate Part C/D policy rule is expected "later this fall".

Sources

• CMS press release CMS-4214-P Primary · 2026-10-16 · checked 2026-10-19
• CMS fact sheet CMS-4214-P Primary · 2026-10-16 · checked 2026-10-19
• Federal Register public inspection 2026-21420 Primary · 2026-10-16 · checked 2026-10-19
• Regulations.gov docket CMS-2026-2533 Primary · checked 2026-10-19

Related on this site

• Policy §2
• Forecast F-01
• Calendar
• Physicians module
• Records ledger

Register: the record store · record id cms-4214-p-medicare-advantage-directories-pbm-2026-10-16 · SOURCE-VERIFIED · HUMAN REVIEW PENDING.