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Medicare-Medicaid Plan (MMP) Application & Annual Requirements

SPOTLIGHT & RELEASES

04/11/2019 - CY 2020 Medication Therapy Management Program Guidance and Submission Instructions (04/05/2019)

04/10/2019 - CY 2020 Submission of Plan Benefit Packages Memorandum (04/08/2019)

04/03/2019 -

Applicability of CY 2020 Final Call Letter Provisions to MMPs (04/02/2019) 

CY 2020 Medicare Advantage Capitation Rates & Part D Payment Policies Final Call Letter (04/01/2019)


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 new organizations and existing MMPs seeking to serve demonstration counties. The MMP application must be completed in conjunction with any applicable state requirements.


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 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.