On April 15, 2011, CMS is publishing a final rule to update Medicare Advantage (MA) and Part D prescription drug benefit regulations to reflect Affordable Care Act (ACA) requirements and make other program changes for contract year 2012. Specifically, the rule implements 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; implement a more uniform Part D exceptions and appeals process; codify changes to the MA benchmark calculation and rebate amounts; 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 (note that in the final rule, CMS is requiring dispensing in increments of 14 days or less effective January 1, 2013, rather than its proposal for dispensing every 7 days or less effective January 1, 2012). In addition to these ACA provisions, the rule clarifies 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 appropriate 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.   While the rule generally is effective June 14, 2011, a number of provisions have earlier or later effective dates (as outlined in tables 1 and 2). CMS estimates that the rule will reduce Medicare spending by about $76 billion for fiscal years (FYs) 2011 through 2016, mainly as a result of the ACA’s reforms to MA payments. The official version of the rule will be available April 15.