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Downloads

• Chapter 1 - General Provisions (PDF)
• Chapter 3 - Marketing Guides Instructions (PDF)
• Chapter 4 - Benefits and Beneficiary Protections (PDF)
• Chapter 5 - Quality Assessment (PDF)
• Chapter 6 - Relationships With Providers (PDF)
• Chapter 7 - Risk Adjustment (PDF)
• Chapter 8 - Payments to Medicare Advantage Organizations (PDF)
• Chapter 9 - Employer/Union Sponsored Group Health Plans (PDF)
• Chapter 10 - MA Organization Compliance with State Law and Preemption by Federal Law (PDF)
• Chapter 11 - Medicare Advantage Application Procedures and Contract Requirements (PDF)
• Chapter 12 - Effect of Change of Ownership (PDF)
• Chapter 13 - Medicare Managed Care Beneficiary Grievances, Organization Determinations, and Appeals Applicable to Medicare Advantage Plans, Cost Plans, and Health Care Prepayment Plans (HCPPs), (collectively referred to as Medicare Health Plans) (PDF)
• Chapter 14 - Contract Determinations and Appeals (PDF)
• Chapter 15 - Intermediate Sanctions (PDF)
• Chapter 16a - Subchapter A - Private Fee-for-Service (PFFS) Plans (PDF)
• Chapter 16b - Subchapter B - Special Needs Plans (PDF)
• Chapter 17a - Subchapter A - TEFRA Cost Based Payment Processes and Principles (PDF)
• Chapter 17b - Subchapter B - Payment Principles for Cost-Based HMOs and CMPs (PDF)
• Chapter 17c - Subchapter C - Cost Apportionment for Cost-Based HMOs and CMPs (PDF)
• Chapter 17d - Subchapter D - Medicare Cost Plan Enrollment and Disenrollment Instructions (PDF)
• Chapter 17f - Subchapter F - Benefits and Beneficiary Protections (PDF)
• Chapter 18a - Subchapter A - Cost-Based Payment Process and Principles (PDF)
• Chapter 18b - Subchapter B - Payment Principles for Cost-Based HMOs and CMPs (PDF)
• Chapter 18c - Subchapter C - Cost Apportionment for Cost-Based HMO/CMPs (PDF)
• Chapter 21 - Compliance Program Guidelines and Prescription Drug Benefit Manual Chapter 9 - Compliance Program Guidelines (PDF)