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Back to Internet-Only Manuals (IOMs)
100-16
Publication #
100-16
Title
Medicare Managed Care Manual
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)
Related Links
Medicare Managed Care Eligibility and Enrollment