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Medicare-Medicaid Plan (MMP) Application & Annual Requirements

RECENT POSTS

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

05/16/2018 - CY 2019 Submissions: MMP Guidance on the Uniformity Requirement & Primarily Health Related Supplemental Benefits (05/15/2018)


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.


Applications

Guidance for existing MMPs seeking to serve additional demonstration counties. The MMP application must be completed in conjunction with any applicable state requirements.

Guidance for states participating in the capitated financial alignment model that are interested in letting existing MMPs serve additional demonstration counties, or are interested in letting new organizations apply to be MMPs in the existing demonstration service area, is available below:


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:


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:


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.


Formulary

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 CY 2019 Medication Therapy Management (MTM) programs including information to assist sponsors with the submission of their CY 2019 MTM programs, the requirements for establishing MTM programs for 2019, and instructions for submitting change requests.

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