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Comment: Several commenters stated concerns that the Maximum Out-Of-Pocket (MOOP) limit is a factor contributing to underpayment for beneficiaries with ESRD. Commenters suggested that CMS update the MA benchmark to incorporate the difference between FFS Medicare out-of- pocket costs and the MA MOOP to support accurate payments for beneficiaries with ESRD. Response: While CMS appreciates the suggestions of commenters, CMS does not find the suggestions to revise the ESRD rate-setting methodology to be consistent with our interpretation of section 1853 of the Act. As explained in the CY 2012 Advance Notice and CY 2012 Rate Announcement, CMS interprets the statutory changes made by the ACA to MA payment to indicate that all MA payment rates, including the separate rates of payment for ESRD enrollees, should closely align with FFS Medicare costs. As provided in section 1853(a)(1)(H) of the Act, CMS establishes separate rates of payment to MA organizations for ESRD beneficiaries enrolled in MA plans. See also §§ 422.254 and 422.304 through 422.308. The rates used for enrollees in dialysis or transplant status are based on statewide average FFS Medicare costs for ESRD beneficiaries in dialysis status. For enrollees with functioning graft status, the MA county benchmark rates are the payment rates. The rates for those in dialysis, transplant, and functioning graft status are also adjusted using a risk adjustment methodology that is specific to the health care costs for beneficiaries with ESRD in dialysis, transplant, or functioning graft status. CMS understands the concern about potential underpayment of ESRD costs leading to increases in costs for all MA enrollees, including those without ESRD; however, the data CMS uses to calculate the CY 2026 MOOP limits includes out-of-pocket expenses from beneficiaries with and without diagnoses of ESRD because the MOOP limits will apply to enrollees with and without diagnoses of ESRD in CY 2026. This practice avoids discriminating against beneficiaries with diagnoses of ESRD — or any group of beneficiaries with a particular high-cost condition or health status — that would result if there were higher premiums, cost sharing, or MOOP amounts applicable only to those individuals with a certain chronic condition. Additional detail on how CMS finalized MOOP limits calculations, including the data used and the percentiles of FFS Medicare data projections that should be used in those calculations is available in the final rule titled “Medicare Program; Maximum Out-of-Pocket (MOOP) Limits and Service Category Cost Sharing Standards” (CMS-4190-FC4) (87 FR 22290) published April 14, 2022. Comment: A few commenters recommended CMS make changes to the Bid Pricing Tool (BPT) to reclassify the ESRD subsidy to be a Medicare-covered service rather than an A/B Mandatory Supplemental benefit. The commenters suggested that in the short term, CMS should make the ESRD and non-ESRD service categories consistent and merge the ESRD and MA BPT format, and in the long-term, CMS should eliminate the ESRD BPT filing altogether as CMS receives the same information through encounter, rebate, and MLR data. Response: CMS appreciates the suggestions submitted by the commenters related to the BPT. Section 1853(a)(1)(H) of the Act requires the Secretary to establish “separate rates of payment” with respect to beneficiaries with ESRD enrolled in MA plans and does not require that a competitive bidding methodology be used for CMS capitation payments for ESRD enrollees. In