General Requirements

10.1 – General Requirements (Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16) These guidelines reflect CMS’ current interpretation of the provisions of the Medicare Advantage statute and regulations (chapter 42 of the Code of Federal Regulations, part 422) pertaining to benefits and beneficiary protections. This guidance is subject to change as technology and industry practices in plan design and administration evolve and as CMS gains additional experience administering the MA program. This chapter is governed by regulations set forth at 42 CFR 422, Subpart C, and is generally limited to the benefits offered under Medicare Part C of the Social Security Act. Guidance on cost plans may be found in Subpart F of chapter 17 of the Medicare Managed Care Manual (MMCM). Guidance on Part D requirements may be found in the Prescription Drug Benefit Manual located at: http://www.cms.gov/Medicare/Prescription- Drug-Coverage/PrescriptionDrugCovContra/PartDManuals.html. Part D prescription drug coverage is defined at 42 CFR 423.100 and in chapter 5 of the Prescription Drug Benefit Manual.