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Information and Guidance for Plans

RECENT POSTS

08/28/2018 - CA CY 2019 Spanish materials: Member Handbook Spanish (2019), Provider & Pharmacy Directory - English & Spanish (2019), Summary of Benefits - English & Spanish (2019), List of Covered Drugs - English & Spanish (2019), & Annual Notice of Change - English & Spanish (2019)  (MMP Marketing Information & Resources page)

08/28/2018 - Revisions: MI Member Handbook (Chapter 4- rev. 08/22/2018) (2018) & (2019), & MI Summary of Benefits (rev. 08/22/2018) (2018) & (2019)  (MMP Marketing Information & Resources page)

08/24/2018 - SC CY 2019 Spanish materials: Member Handbook Spanish (2019), Provider & Pharmacy Directory - English & Spanish (2019), Summary of Benefits - English & Spanish (2019), List of Covered Drugs - English & Spanish (2019), & Annual Notice of Change - English & Spanish (2019)   (MMP Marketing Information & Resources page)

08/24/2018 - NY FIDA CY 2019 Spanish materials: Member Handbook Spanish (2019), Provider & Pharmacy Directory - English & Spanish (2019), Summary of Benefits - English & Spanish (2019), List of Covered Drugs - English & Spanish (2019), & Annual Notice of Change - English & Spanish (2019)  (MMP Marketing Information & Resources page)

08/24/2018 - NY FIDA-IDD CY 2019 Spanish materials: Member Handbook Spanish (2019), Provider & Pharmacy Directory - English & Spanish (2019), Summary of Benefits - English & Spanish (2019), List of Covered Drugs - English & Spanish (2019), & Annual Notice of Change - English & Spanish (2019)  (MMP Marketing Information & Resources page)

08/24/2018 - Delegated Notices (P2-P5): NY FIDA (2019) & NY FIDA-IDD (2019)  (MMP Marketing Information & Resources page)

08/24/2018 - Revisions: NY FIDA Member Handbook (Chapter 4- rev. 08/16/2018) English (2019)  (MMP Marketing Information & Resources page)

08/24/2018 - Revisions: SC Member Handbook (Chapter 4- rev. 08/16/2018) English (2018) & (2019) &  SC Member Handbook (Chapter 4- rev. 08/21/2018) Spanish (2018)  (MMP Marketing Information & Resources page)

08/24/2018 - Revisions: CY 2019 MMP Marketing & Beneficiary Communications Guidance (08/20/2018) & CY 2019 MSHO Marketing & Beneficiary Communications Guidance (08/20/2018)  (MMP Marketing Information & Resources page)

08/17/2018 - Capitated Financial Alignment Demonstration Years 2-4 QW Methodology for Rhode Island  (MMP Quality Withhold Methodology & Technical Notes page)

08/15/2018 - CY 2019 Explanation of Benefits - Integrated & CY 2019 Explanation of Benefits - Drug-Only  (MMP Marketing Information & Resources page)

08/14/2018 - Capitated Financial Alignment Demonstration Years 2-5 QW Methodology for Illinois (rev. 08/10/2018)  (MMP Quality Withhold Methodology & Technical Notes page)

08/09/2018 - CY 2019 CA materials: Member Handbook (English - Chapters 9 & 11 (2019)) & Integrated Denial Notices (2019)  (MMP Marketing Information & Resources page)

08/09/2018 CY 2019 MMP Marketing & Beneficiary Communications Guidance (08/03/2018) & CY 2019 MSHO Marketing & Beneficiary Communications Guidance (08/03/2018)  (MMP Marketing Information & Resources page)

08/08/2018 - CY 2018 MMP and MN Senior Health Options D-SNPs Network Submission Guidance & CY 2018 MMP and MN Senior Health Options D-SNPs Network Submission Instructions  (MMP Application & Annual Requirements page)

08/06/2018 - CY 2019 materials: Explanation of Benefits (EOB) - Drug Only & Integrated (IL  (2019)) & Drug Only (MI (2019), OH (2019) & SC (2019)); Delegated Notices (IL - Exhibits 4 & 16-30 (2019)); & Member Handbook (MI - Chapter 9 (2019))  (MMP Marketing Information & Resources page)

08/06/2018 - CY 2019 MMP & Minnesota Senior Health Options (MSHO) Member Material Updates Memo (07/30/2018)  (MMP Marketing Information & Resources page)

08/06/2018 - National Enrollment/Disenrollment Guidance for States & MMPs (released 08/02/2018; effective 01/01/2019) & Coordinating Passive Enrollment with Medicare Reassignment (07/27/2018)

(MMP Enrollment page)

07/31/2018 - MMP & MSHO Plan Errata (07/31/2018)  (MMP Marketing Information & Resources page)

07/30/2018 - TX CY 2019 Spanish materials: Member Handbook Spanish (2019), Provider & Pharmacy Directory - English & Spanish (2019), Summary of Benefits - English & Spanish (2019), List of Covered Drugs - English & Spanish (2019), & Annual Notice of Change - English & Spanish (2019)  (MMP Marketing Information & Resources page)

07/30/2018 - OH CY 2019 Spanish materials: Member Handbook Spanish (2019), Provider & Pharmacy Directory - English & Spanish (2019), Summary of Benefits - English & Spanish (2019), List of Covered Drugs - English & Spanish  (2019), & Annual Notice of Change - English & Spanish (2019)  (MMP Marketing Information & Resources page)

07/30/2018 - NY (FIDA-IDD Model) & NY (FIDA Model) CY 2019 materials: Explanation of Benefits (EOB) - Drug Only (NY FIDA) (2019) & Explanation of Benefits (EOB) - Drug Only (NY FIDA-IDD) (2019)  (MMP Marketing Information & Resources page)

07/30/2018 - MI CY 2019 materials: CY 2019 Marketing Guidance for Michigan MMPs (07/23/2018), Member ID Card (2019), Member Handbook (2019), Provider & Pharmacy Directory (2019), Summary of Benefits (2019), List of Covered Drugs (2019), Delegated Notices (2019), Integrated Denial Notice (2019), Late Coverage Decision Notice (2019), Appeals Notices (2019), & Annual Notice of Change (2019)  (MMP Marketing Information & Resources page)

07/30/2018 - CY 2018 MMP Provider & Pharmacy Directory Monitoring Frequently Asked Questions (FAQs) (07/25/2018)  (MMP Marketing Information & Resources page)


Overview

This page includes information and guidance for Medicare-Medicaid Plans (MMPs) participating in the Financial Alignment Initiative capitated model demonstrations and the Minnesota Demonstration to Integrate Care for Dual Eligibles in the following areas:

  • Application & Annual Requirements
  • Reporting Requirements
  • Audit Programs
  • Enrollment
  • Encounter Data Reporting
  • Marketing Information & Resources
  • Quality Withhold Methodology & Technical Notes
  • Chronic Care Improvement Programs & Quality Improvement Projects

Email us if you need more information about MMP requirements.

More information on each state's demonstration can be found on the Financial Alignment Initiative page.

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