CMS Program Integrity Rule Court Decision Update

On August 22, 2025 a federal court in Maryland paused several parts of CMS’ Program Integrity Rule that were set to take effect August 25, 2025.

Key Points:

• SEP pre-enrollment verification expansion – paused

• $5 premium for $0 passive renewals – paused

• Certain income DMI requirements – paused

CMS is expected to issue guidance for the 2026 OEP—we’ll share updates as soon as we have them.