2027 RxHCC Final Rule Summary
The CY2027 Rate Announcement (released April 6, 2026) finalizes the Part D risk adjustment model plans will be paid on for 2027. Here is the summary that matters for MA-PD plans, PDPs, PBMs, and ACOs — with the deep dive in CY2027 model changes.
Finalized at a glance
| Element | CY2027 final policy | Source |
|---|---|---|
| Calibration data | 2023 diagnoses → 2024 expenditures | Rate Announcement, Att. VIII |
| Plan-type segments | Separate MA-PD and PDP model segments | Att. VIII, Tables VIII-1–VIII-12 |
| Normalization (MA-PD) | 1.109 | Att. VIII |
| Normalization (PDP) | 1.005 | Att. VIII |
| PACE | 50/50 blend of 2023/2024 and 2018/2019 calibrations; 1.237 on the latter | Att. VIII |
| Audio-only diagnoses | Excluded | Att. VIII |
| Unlinked chart review records | Excluded (except members who change plans between diagnosis and payment years) | Att. VIII |
| IRA reflection | CY2027 benefit design, MFP gross-cost adjustments, small-manufacturer discount phase-in | Att. VIII |
| Hierarchies | Unchanged; apply across all RxHCC models | Table VIII-13 |
What this means in one paragraph
CMS rebuilt the Part D model on post-IRA economics and recent data, split it by plan type, and tightened what counts as a payable diagnosis. The combined effect: MA-PD and PDP bids built on 2026 assumptions are wrong in both directions — some coefficients rose ~19% (multiple myeloma), others fell, and the normalization gap between plan types is roughly ten points. The numeric detail is in our 2027 coefficients table.
Frequently asked questions
Is this the same as the "2027 final rule"?
The Rate Announcement is the annual payment-policy document (distinct from the CY2027 MA/Part D final rule published separately). The RxHCC model changes live in the Rate Announcement, Attachment VIII.
When do plans feel this?
CY2027 bids were due June 2026; payment impacts begin January 1, 2027. Retrospective modeling now is how you find the gap before CMS payments do.