General

110.2.1 – General (Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16) Pursuant to 42 CFR §422.111(b)(3) MAOs must provide the number, mix, and distribution (addresses) of providers from whom enrollees may reasonably be expected to obtain services. If an MAO chooses to develop a non-model provider directory for either hardcopy or online provider directories, the directory must contain all information and follow all instructions within the CMS model provider directory located at: http://www.cms.gov/Medicare/Health- Plans/ManagedCareMarketing/MarketngModelsStandardDocumentsandEducationalMat erial.html. This includes the introductory language and disclaimers. MAOs can find complete website and electronic media related requirements at section 100 of the Medicare Marketing Guidelines. MAOs must include information regarding all contracted network providers in directories at the time of enrollment. Directories must include information about the number, mix, and distribution of all network providers. MAOs may have separate directories for each geographic area they serve, (e.g., metropolitan areas, surrounding county areas), provided that all directories together cover the entire service area. MAOs may print a separate directory for each sub-network and disseminate that information to enrollees residing in that particular geographic sub-network. To ensure that enrollees are fully aware of their overall network provider options, plans that furnish their enrollees with directories containing a sub-network of plan providers must also advise enrollees that the complete directory of network providers is available online and that it will be furnished in hard copy upon request.in plans that have sub-networks. MAOs also may publish separate primary care physician (PCP) and specialty physician directories provided both directories are available, online and hard copy, to enrollees at the time of enrollment and throughout the contract year. MAOs’ MA-PD plans may combine the model provider and model pharmacy directories in one document. The guidance in this section, combined with the specific guidance on pharmacy directories, should be followed when creating a combined provider/pharmacy directory.