Coordinated Care Plans (CCPs)

20.2 - Coordinated Care Plans (CCPs) (Rev. 124, Issued: 11-10-16; Effective: 11-10-16; Implementation: 11-10-16) As defined at 42 CFR 422.4(a)(1), a CCP is a plan that includes a network of providers that are under contract or arrangement with the MA organization to deliver the benefit package approved by CMS. A CCP must at least (i) furnish all Part A and Part B services (except for hospice) (42 CFR 422.101(a)); (ii) conduct quality improvement activities (42 CFR 422.152(a)–(b)); (iii) provide sufficient access, as defined by CMS, to services including continuity of care (42 CFR 422.112(a)–(b)); and (iv) disclose required information about benefits and costs to enrollees (42 CFR 422.111(b)(2)). CCPs may use mechanisms to control enrollee utilization of services. Mechanisms may include requiring referrals from a gatekeeper (usually the enrollee’s primary care provider (PCP)) or prior authorization for an enrollee to receive certain covered services (42 CFR 422.4(a)(1)(ii)).