42 C.F.R. § 423.2516
Selection of LI NET sponsor and contracting provisions.
Cite as 42 C.F.R. § 423.2516 (2026)
(a)
Appointment by CMS.
CMS appoints a Part D sponsor that meets the requirements at § 423.2512 to serve as the LI NET sponsor.
(b)
Selection criteria.
In appointing a LI NET sponsor, CMS evaluates the following:
(1) Experience covering low-income beneficiaries, including but not limited to enrolling and providing coverage to low-income subsidy individuals as defined in § 423.34;
(2) Pharmacy access as outlined in § 423.120;
(3) Past performance, including Star Ratings (as detailed in § 423.186), previous intermediate sanctions (as detailed in § 423.750), and consistent with past performance in § 423.503(b); and
(4) Ability to meet the requirements listed in § 423.505 that are not waived under § 423.2536.
(c)
Term of appointment.
The term of the appointment will be ongoing provided mutual agreement between CMS and the selected party, subject to an annual contracting and bid process (per § 423.2524(b)) to determine payment rates for the upcoming year.
- Cross-references to the CFR
- 423.120423.186423.2512423.2524423.2536.423.34423.503423.505423.750