Publication #
100-16
Title
Medicare Managed Care Manual
Downloads
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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)