Medicare-Medicaid Plan (MMP) Application & Annual Requirements
|08/09/2023: CMS released the CY 2023 MMP Health Service Delivery (HSD) Network Submission Guidance Memorandum & Instructions. More information is available below.|
Prior to each contract year, the Centers for Medicare and Medicaid Services (CMS) provides information about the Medicare requirements and timeframes for renewal of MMP contracts, including information about plan benefit package, formulary, and Medication Therapy Management (MTM) program submissions. More information is available by topic below.
Guidance for new organizations and existing MMPs seeking to serve demonstration counties. The MMP application must be completed in conjunction with any applicable state requirements.
Medicare Parts C and D Annual Calendar
The Medicare Parts C and D annual calendar is regularly updated and available to download on the Health Plan Management System page available to the public. This calendar is a listing of key dates and timelines for the operational activities that pertain to the Medicare Advantage (MA) plans, Medicare Advantage-Prescription Drug (MA-PD) plans, Prescription Drug Plans (PDPs), MMPs, and cost-based plans.
Network Adequacy for MMPs
Every year, CMS reviews the adequacy of each MMP's contracted provider network. More information on MMP Medicare standards for annual network adequacy is available below:
- CY 2023 MMP Health Service Delivery (HSD) Network Submission Guidance Memorandum
- CY 2023 MMP Health Service Delivery (HSD) Network Submission Instructions
- CY 2023 MMP Health Service Delivery (HSD) Network Adequacy Standards Criteria Reference Table
Plan Benefit Package
MMPs participating in the capitated model demonstrations must follow CMS and state guidance for plan benefit package (PBP) submissions. Guidance supports timely and accurate submission of MMP plan benefit packages that integrate all Medicare, Medicaid, and demonstration-specific benefits.
- CY 2024 Submission of Plan Benefit Packages Memorandum (04/14/2023) (PDF)
- Part D Low-Income Subsidy Cost-Sharing Amounts by Medicare-Medicaid Plans (PDF)
Each contract year, MMPs must submit and be approved to offer a demonstration-specific, integrated formulary that meets both Medicare Part D and Medicaid requirements. The required submissions for the integrated formulary are: (1) an updated base Part D formulary and supplemental Part D formulary files, as applicable; and (2) an updated Additional Demonstration Drug (ADD) file containing non-Part D drugs.
Medication Therapy Management Programs
Guidance for Part D sponsors regarding Medication Therapy Management (MTM) programs including information to assist sponsors with the submission of their MTM programs, the requirements for establishing MTM programs, and instructions for submitting change requests.