Federal (United States) · Agency guidance
Chapter 4
150 sections
150 sections
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10Introduction
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.1General Requirements
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.2Basic Rule
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.2.1Inpatient Stay During Which Enrollment Ends
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.2.2Exceptions to Requirement for MA plans to Cover FFS Benefits
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.3Types of Benefits
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.4Hospice Coverage
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.5Federal Medicare Requirements Related to Uniform Benefits and
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.5.1Uniformity
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.5.2Anti-Discrimination
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.5.3Review for Discrimination and Steering
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.5.4Confidentiality
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.6Multiple Plan Offerings and Benefit Caps
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.7Clinical Trials
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.7.1Payment for Services
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.7.2Payment for Investigational Device Exemption (IDE) Studies
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.7.3Payment for Clinical Studies Approved Under Coverage with
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.7.4Claims Processing Instructions for Clinical Studies
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.8Drugs Covered Under Original Medicare Part B
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.9Return to Enrollee’s Home Skilled Nursing Facility (SNF)
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.10Therapy Caps and Exceptions
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.11Transplant Services
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.12Durable Medical Equipment, Prosthetics, Orthotics and
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.12.1Designation of DME Providers/Suppliers
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.12.2Specifying Brands or Manufacturers of DME
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.12.3Brands/Manufacturers of DME not Subject to Limitation
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.12.4Prosthetics and Orthotics
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.12.5DMEPOS Competitive Bid Program
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.13Skilled Nursing Facility (SNF) Coverage
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.14No Dollar Limits on Provision of Part B Drugs
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.15Part D Rules for MA Plans
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 10.16Medical Necessity
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 20Ambulance, Emergency, Urgently Needed and Post-Stabilization
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 20.1Ambulance Services
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 20.2Definitions of Emergency and Urgently Needed Services
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 20.3MAO Responsibilities for Coverage of Emergency Services
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 20.4Stabilization of an Emergency Medical Condition
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 20.5Post-Stabilization Care Services
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 20.5.1Definition of Post-Stabilization
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 20.5.2MAO Financial Responsibility
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 20.5.3End of Post-Stabilization
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 20.5.4Cost-Sharing
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 30Supplemental Benefits
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 30.1Definition of Supplemental Benefit
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 30.2Supplemental Benefits Extending Original Medicare Benefits
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 30.3Examples of Eligible Supplemental Benefits
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 30.4Items and Services Not Eligible as Supplemental Benefits
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 40Over-the-Counter (OTC) Benefits
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 40.1Overview of OTC Benefit
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 40.2Access to OTC Benefits
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 40.3Payment Methods
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 40.3.1Special Rules for Manual Reimbursement
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 40.4Items and Their OTC Status
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 50Cost-sharing Guidance
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 50.1Guidance on Acceptable Cost-sharing
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 50.2Cost-sharing for In Network Preventive Services
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 50.3Total Beneficiary Cost (TBC)
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 50.4Single Deductible Rules for Regional and Local PPOs
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 50.5Guidance on Other Enrollee Out-of-Pocket Liability
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 50.6Cost Sharing for Dual-Eligible Enrollees Requiring an Institutional
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 60Meaningful Difference
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 70Non-Renewal Based on Low Enrollment
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 80Value-Added Items and Services (VAIS)
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 80.1Definition and Requirements
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 80.2Explanatory Examples
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 90National and Local Coverage Determinations
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 90.1Overview
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 90.2Definitions Related to National Coverage Determinations (NCDs)
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 90.3General Rules for NCDs
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 90.3.1When the Significant Cost Criterion is Not Met
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 90.3.2When the Significant Cost Criterion is Met
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 90.3.3Payment for NCD Items and Services
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 90.4Local Coverage Determinations (LCDs)
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 90.4.1MAC with Exclusive Jurisdiction over a Medicare Item or
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 90.4.2Multiple A/B MACs with Different Policies
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 90.5Creating New Guidance
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 90.6Sources for Obtaining Information
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 100Rewards and Incentives
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 100.1Health-Related Services and Activities
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 100.2Non-discrimination
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 100.3Offering Rewards In Connection With the Entire Service or
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 100.4Valuing Rewards and Incentives
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 100.5Permissible Rewards and Incentives
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 100.6Marketing RI Programs
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 100.7Reporting to CMS
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 110Access to and Availability of Services
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 110.1Access and Availability Rules for Coordinated Care Plans
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 110.1.1Provider Network Standards
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 110.1.2Significant Changes to Networks
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 110.1.2.1General
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 110.1.2.2Notification to CMS
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 110.1.2.3Notification to Enrollees
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 110.1.2.4MAO/Provider Notification
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 110.1.2.5Significant Network Change Special Election Period (SEP)
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 110.1.3Services for Which MA Plans Must Pay Non-contracted
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 110.2Provider Directories
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 110.2.1General
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 110.2.2Provider Directory Updates
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 110.2.3Provider Directory Dissemination and Timing
- Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 110.2.4Online Provider Directory Requirements