This page is dedicated to newly released material related to the Medicare Advantage (MA)program.
Updates to Chapters 1, 4, 5, 10, 16a, and 16b
CMS has released an update to Chapter 5, "Quality Assessment," as well as Chapter 10, "MA Organization Compliance with State Law and Preemption by Federal Law," of the Medicare Managed Care Manual in August 2011. Chapter 5 provides Medicare Advantage (MA) organizations with detailed, updated information to use in implementing and maintaining a quality improvement (QI) program. Chapter 10 reflects current CMS preemption policy and further clarifies this issue for MA organizations.
CMS previously released an update to Chapter 4, "Benefits and Beneficiary Protections," as well as new Chapters 16a, "Private Fee-for-Service Plans," and 16b, "Special Needs Plans," of the Medicare Managed Care Manual in May 2011. The revisions to Chapter 4 and the introduction of Chapters 16a and 16b reflect new regulatory requirements and guidance for Medicare Advantage organizations and employer/union-sponsored group health plans. In addition, the updated Chapter 1, "General Provisions," which was released in January 2011, can still be accessed from this page by clicking the links below to "Chapter 1 HPMS Cover Memo" and "Chapter 1 Update." Click below on the link to "Chapter 4 5 10 16a and 16b HPMS Cover Memos" for further details on each chapter. Click on the link to "Internet Only Manuals" to find the updated chapters.
New Regulations – Revisions to the Medicare Advantage and Prescription Drug Benefit Programs
On April 5, 2011, CMS released a final rule titled "Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs for Contract Year 2012 and Other Changes (CMS-4144-F)." CMS finalized revisions to the Medicare Advantage (MA) program (Part C) and Prescription Drug Benefit program (Part D) to implement provisions specified in the Affordable Care Act and make other changes to the regulations based on our continued experience in the administration of the Parts C and D programs. Click on the link for CMS-4144-F below to access this final rule.
On September 1, 2011, the Federal Register published a final rule titled "Revisions to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs." CMS finalized provisions from three interim final rules released in September and November 2008, which implemented provisions enacted by the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. Some of the 24 provisions that were finalized in this rule include those codifying requirements specific to Special Needs Plans; clarifying requirements for quality improvement programs; addressing issues related to Part D claims and pricing; and defining Part C and Part D marketing requirements. Click on the link for "CMS-4138-F" below to access this final rule.
New Medicare Advantage Guidance Issued: Impact of United States v. Windsor on Skilled Nursing Facility Benefits for Medicare Advantage Enrollees
CMS recently issued a memorandum advising that, effective immediately, in accordance with the Supreme Court’s ruling in United States v. Windsor, Medicare Advantage (MA) organizations must cover services in a skilled nursing facility (SNF) in which a validly married same sex spouse resides to the extent that they would be required to cover the services if an opposite sex spouse resided in the SNF. The memorandum, "SNF_Benefits_Post_Windsor", is available in the download section at the bottom of this page.
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