Medicare-Medicaid Plan (MMP) Application & Annual Requirements
|SPOTLIGHT & RELEASES|
Prior to each contract year, the Centers for Medicare and Medicaid Services (CMS) provides information about the Medicare requirements and timeframes for renewal of MMP contracts, including information about plan benefit package, formulary, and Medication Therapy Management (MTM) program submissions. More information is available by topic below.
Guidance for new organizations and existing MMPs seeking to serve demonstration counties. The MMP application must be completed in conjunction with any applicable state requirements.
- CY 2021 Notice of Intent to Apply (NOIA) for the Medicare Advantage (MA), Medicare-Medicaid Plans (MMP), & Prescription Drug Benefit (Part D) Application Cycle
- CY 2020 MMP Initial & Service Area Expansion (SAE) Application (PDF)
General Annual Program Guidance
Each year, CMS provides MMPs participating in capitated model demonstrations general program guidance in the Parts C and D Final Call Letter. Additional information is available below:
- Applicability of CY 2020 Final Call Letter Provisions to MMPs (04/02/2019) (PDF)
- CY 2020 Medicare Advantage Capitation Rates & Part D Payment Policies Final Call Letter (04/01/2019) (PDF)
- Capitated Financial Alignment Model Plan Guidance (01/25/2012) (PDF)
Network Adequacy for MMPs
Every year, CMS reviews the adequacy of each MMP's contracted provider network. More information on MMP Medicare standards for annual network adequacy is available below:
- CY 2019 MMP Health Service Delivery (HSD) Network Submission Guidance (PDF)
- CY 2019 MMP Health Service Delivery (HSD) Network Submission Instructions (PDF)
- CY 2019 MMP Health Service Delivery (HSD) Network Adequacy Standards Criteria Reference Table (XLSX)
Plan Benefit Package
MMPs participating in the capitated model demonstrations must follow CMS and state guidance for plan benefit package (PBP) submissions. Guidance supports timely and accurate submission of MMP plan benefit packages that integrate all Medicare, Medicaid, and demonstration-specific benefits.
- CY 2020 Submission of Plan Benefit Packages Memorandum (04/08/2019) (PDF)
- CY 2019 Supplemental Benefits Offered by MMPs (PDF)
- CY 2018 Supplemental Benefits Offered by MMPs (PDF)
- Part D Low-Income Subsidy Cost-Sharing Amounts by Medicare-Medicaid Plans
Each contract year, MMPs must submit and be approved to offer a demonstration-specific, integrated formulary that meets both Medicare Part D and Medicaid requirements. The required submissions for the integrated formulary are: (1) an updated base Part D formulary and supplemental Part D formulary files, as applicable; and (2) an updated Additional Demonstration Drug (ADD) file containing non-Part D drugs.
Medication Therapy Management Programs
Guidance for Part D sponsors regarding Medication Therapy Management (MTM) programs including information to assist sponsors with the submission of their MTM programs, the requirements for establishing MTM programs, and instructions for submitting change requests.