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Advance Notice by applying 100 percent of the medical education technical adjustment for CY 2026. Calculation of FFS Costs: As has been the case for the last nine years, the Secretary has directed the CMS OACT to adjust the FFS experience for beneficiaries enrolled in Puerto Rico to reflect the nationwide propensity of beneficiaries with zero claims. For future years, CMS plans to continue to evaluate the methodology for calculating rates for Puerto Rico plans to ensure the rates are based on the best estimates of Medicare FFS per capita costs in Puerto Rico and reassess the need for ongoing special adjustments. MA Benchmark, Quality Bonus Payments, and Rebate: We will continue to implement the methodology, as described in the CY 2026 Advance Notice, used to derive the benchmark county rates, how the qualifying bonus counties are identified, and the applicability of the Star Ratings. Location of Network Areas for Private Fee-for-Service (PFFS) Plans in Plan Year 2027: The list of network areas for plan year 2027 is available on the CMS website at https://www.cms.gov/medicare/health-drug-plans/private-fee-for-service-plans/network- requirements. Direct Graduate Medical Education (DGME) Carve-out Applied to Average Geographic Adjustments (AGAs): As in past years, we will continue carving out FFS DGME amounts from the MA capitation rates as described in the CY 2026 Advance Notice. (This is different than the technical update related to medical education payments on behalf of MA enrollees in the non- ESRD USPCC baseline discussed above.) Indirect Medical Education (IME) Phase Out Applied to AGAs: We will continue phasing out FFS IME amounts from the MA capitation rates as described in the CY 2026 Advance Notice. Organ Acquisition Costs for Kidney Transplants: As in past years, we will continue carving out Kidney Acquisition Costs from the MA capitation rates. As described in the CY 2026 Advance Notice, we will use a different data source and methodology to develop the Kidney Acquisition Cost amounts to carve out for hospitals participating in the Maryland Total Cost of Care Model. MA ESRD Rates: We will continue to set MA ESRD rates on a state basis. We will apply the $6.00 per month Network withhold amount to the ESRD rates beginning in CY 2026. MA Employer Group Waiver Plans (EGWPs): We will continue to use the payment methodology as described in the Advance Notice, but with finalized bid-to-benchmark ratios for CY 2026 MA EGWP payment rates as indicated in the table below.