CMS019326 - Centers for Medicare & Medicaid Services

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Publication #: 100-16
Title: Medicare Managed Care Manual

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Chapter 1 - General Provisions [PDF, 132KB]
Chapter 3 - Click here for Marketing Guides Instructions [PDF, 1MB]
Chapter 4 - Benefits and Beneficiary Protections [PDF, 688KB]
Chapter 5 - Quality Assessment [PDF, 566KB]
Chapter 6 - Relationships With Providers [PDF, 146KB]
Chapter 8 - Payments to Medicare Advantage Organizations [PDF, 235KB]
Chapter 9 - Employer/Union Sponsored Group Health Plans [PDF, 257KB]
Chapter 10 - MA Organization Compliance with State Law and Preemption by Federal Law [PDF, 44KB]
Chapter 11 - Medicare Advantage Application Procedures and Contract Requirements [PDF, 294KB]
Chapter 12 - Effect of Change of Ownership [PDF, 74KB]
Chapter 13 - Medicare Managed Care Beneficiary Grievances, Organization Determinations, and Appeals Applicable to Medicare Advantage Plans, Cost Plans, and Health Care Prepayment Plans (HCPPs), (collectively referred to as Medicare Health Plans) [PDF, 426KB]
Chapter 14 - Contract Determinations and Appeals [PDF, 73KB]
Chapter 15 - Intermediate Sanctions [PDF, 56KB]
Chapter 16a - Subchapter A - Private Fee-for-Service (PFFS) Plans [PDF, 198KB]
Chapter 16b - Subchapter B - Special Needs Plans [PDF, 433KB]
Chapter 17a - Subchapter A - TEFRA Cost Based Payment Processes and Principles [PDF, 132KB]
Chapter 17b - Subchapter B - Payment Principles for Cost-Based HMOs and CMPs [PDF, 283KB]
Chapter 17c - Subchapter C - Cost Apportionment for Cost-Based HMOs and CMPs [PDF, 60KB]
Chapter 17d - Subchapter D - Medicare Cost Plan Enrollment and Disenrollment Instructions [PDF, 381KB]
Chapter 17f - Subchapter F - Benefits and Beneficiary Protections [PDF, 227KB]
Chapter 18a - Subchapter A - Cost-Based Payment Process and Principles [PDF, 100KB]
Chapter 18b - Subchapter B - Payment Principles for Cost-Based HMOs and CMPs [PDF, 234KB]
Chapter 18c - Subchapter C - Cost Apportionment for Cost-Based HMO/CMPs [PDF, 145KB]
Chapter 21 - Compliance Program Guidelines and Prescription Drug Benefit Manual Chapter 9 - Compliance Program Guidelines [PDF, 289KB]
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