Overview

90.1 – Overview (Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16) MAOs are expected to stay apprised of new and/or changing Medicare Part A and Part B coverage policies, including those that result from CMS’s National Coverage Determination (NCD) process. Information regarding NCDs is continuously updated on the CMS website at: http://www.cms.hhs.gov/center/coverage.asp. See section 90.6 of this chapter for a list of CMS website sources containing information. As discussed in section 10.2 of this chapter, an item or service classified as an original Medicare benefit must be covered by every MA plan if: • Its coverage is consistent with general coverage guidelines included in original Medicare regulations, manuals and instructions (unless superseded by written CMS instructions or regulations regarding Part C of the Medicare program); • It is covered by CMS’ national coverage determinations (see sections 90.3 and 90.4, below); or • It is covered by written coverage decisions of local Medicare Administrative Contractors (MACs) with jurisdiction for claims in the geographic area in which services are covered under the MA plan, as described in section 90.2 below.