Medicare-Medicaid Plan (MMP) Audit Programs

General Information

CMS conducts program audits of MMPs, Medicare Advantage Organizations (MAOs), and Prescription Drug Plans (PDPs), collectively referred to as "sponsors" to help drive the industry towards improvements in the delivery of health care services. CMS Medicare Advantage Parts C and D program audits for sponsors that include an MMP utilize the Center for Medicare Program Audit Protocols as well as two MMP-specific protocols designed to ensure compliance with three-way contract requirements in the following areas:

1. Medicare-Medicaid Plan Care Coordination (MMPCC) &/OR MMP Care Coordination & Quality Improvement Program Effectiveness (MMP-CCQIPE) Program Area
2. MMP Service Authorization Requests, Appeals and Grievances (SARAG) Program Area

Audit Protocols

• 2022 MMP Program Audit Memo (PDF)
  • 2022 MMP Audit Protocols Attachment A [Comments & Responses] (PDF)
  • 2022 MMP Audit Protocols Attachment B [Crosswalk of Updates] (PDF)
  • 2022 MMP-SARAG Audit Program Protocols (PDF)
  • 2022 MMPCC Audit Program Protocols (PDF)
  • 2022 MMPCC Supplemental Questionnaire (PDF)

• 2021 MMP Program Audit Update Memo (PDF)
  • 2020 MMP-CCQIPE Audit Process and Data Request (PDF)
  • 2020 MMP-CCQIPE Supplemental Questionnaire (ZIP)
  • 2020 MMP-SARAG Audit Process and Data Request (PDF)

More information about the Program Audit Process, Protocols, and Enforcement can be found on the CM Part C and Part D Program Audits page. Specific questions on Program Audits may be submitted to the Part C and D Audits mailbox. Specific questions on MMP audits may be submitted to the MMCO mailbox.

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