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pre-ACA formula, which results in some plans not receiving the full quality bonus if the benchmark exceeds the cap. Response: As we have stated in response to similar comments in prior Rate Announcements,5 while we appreciate the commenters’ concerns, we have not identified discretion under section 1853(n)(4) of the Act to eliminate application of the pre-Patient Protection and Affordable Care Act (ACA) (Pub. L. 111-148) rate cap or exclude the bonus payment or quartile adjustment from the cap calculation. The applicable amount (i.e., “benchmark cap”) is the rate established under section 1853(k)(1) of the Act. Section D. Calculation of Fee-for-Service Costs Comment: A couple of commenters requested that CMS provide more transparency into its methodology for rebasing, given the regional variations in pandemic impacts. Commenters requested that CMS provide further detail explaining the year-over-year changes in FFS spending, the key factors driving these changes, and the relative sensitivity of these estimates to changes in underlying source data. Response: We appreciate the request for transparency and believe that we have been responsive to stakeholders’ interest in understanding and analyzing the rebasing methodology. As noted on page 30 of the CY 2026 Advance Notice, CMS released the 2023 FFS cost data by county used for rebasing county rates in the development of the 2026 ratebook. This data is available on the CMS website at https://www.cms.gov/Medicare/Health- Plans/MedicareAdvtgSpecRateStats/FFS-Data.html. Due to timing constraints, this publicly posted data did not reflect adjustments for Innovation Center models and demonstrations and the Medicare Shared Savings Program and Advanced Alternative Payment Models when posted, and the publicly posted data did not reflect adjustments for claim repricing for the most current available Medicare FFS payment rules and parameters. However, those adjustments are included in the data we used for the MA ratebook. Starting with the CY 2020 Advance Notice, CMS has published with each Advance Notice the latest FFS cost data by county used in the development of the non-ESRD ratebooks. For the CY 2019 Advance Notice and prior, this FFS cost data was released at the same time as the Rate Announcement on the CMS webpage at: https://www.cms.gov/Medicare/Health- Plans/MedicareAdvtgSpecRateStats/FFS-Data. The accelerated release of the FFS experience allows stakeholders to conduct basic analyses of the impact of recent program experience on the geographic adjustments supporting the rates.

5 Please refer to previous Rate Announcements for years 2016 through 2024 available at https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/announcements-and-documents