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CMS adjusts September plan payment user fees

The August 31 MARx memo describes September payment-cycle fee true-ups and prior August MLR adjustments. Its annual collection mechanics distinguish MA-PD and PDP treatment, without announcing a new October fee or a universal provider payment change.

What happened

CMS schedules the September 2026 plan payment for September 1 and describes final annual COB and NMEC fee adjustments. To collect the $0.65 annual COB fee per member, the January–August monthly rate of 7.2 cents becomes 7.4 cents for September. The MA-PD NMEC collection rate rises from 0.021 percent to 0.029 percent to reach the $108.9 million annual amount. September includes no PDP NMEC assessment because the $11.4 million maximum was reached in August. These are distinct plan-payment calculations, rather than one percentage applied to every Medicare payment.

The memo places required 2024 medical-loss-ratio remittances in the August 2026 payment under the PPR adjustment code MLR. It separately reiterates the restored 2 percent statutory sequester and corresponding retroactive adjustments. For payment inquiries, CMS points plans to the MAPD Help Desk and explains that organizations with an already submitted trouble ticket need not resubmit it, including where a common parent ticket consolidates issues. Those reconciliation instructions do not establish that a particular organization owes a new amount or that October brought another fee-rate change.

Scope and timing

Authority status
Final
Applicability
Potentially applicable
Audience
Health systems, Provider networks
Jurisdiction
Federal
Affected functions
Finance, Managed Care, Compliance
Responsible owner
Finance

Why it matters

Health systems or networks with plan operations need to reconcile the September 1 payment against the final annual fee adjustments. The memo places 2024 medical-loss-ratio remittances in the August payment, under code MLR.

Sources

Complete edition and supplemental material

This finding in the complete approved report →

Regulatory horizons, CIA trends and implementation trackers remain in the full report.

Read the entire Medicare & Medicaid report →

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