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Guidance resources for health plans preparing their Plan Benefit Packages (PBPs) for Part C benefits

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<div class="row"><div class="col-lg-4 col-sm-12 text-center" id="guidance"><a data-parent="#detail-panel-group" data-target="#guidance-detail-section" data-toggle="collapse"><img alt="Guidance" class="img-circle if-collapsed" data-holder-rendered="true" height="93" src="/mabenefitsmailbox/Content/lmi/images/guidance01.png" width="93" /><img alt="Guidance" class="img-circle if-not-collapsed" data-holder-rendered="true" height="93" src="/mabenefitsmailbox/Content/lmi/images/minus_icon.png" width="93" /></a><h3><a data-parent="#detail-panel-group" data-target="#guidance-detail-section" data-toggle="collapse">Guidance</a></h3><p>CMS guidance documents related to Part C benefits policy.</p></div><div class="col-lg-4 col-sm-12 text-center" id="questions"><a class="collapsed" data-parent="#detail-panel-group" data-target="#questions-detail-section" data-toggle="collapse"><img alt="Questions & Answers" class="img-circle if-collapsed" data-holder-rendered="true" height="93" src="/mabenefitsmailbox/Content/lmi/images/questions01.png" width="93" /><img alt="Questions & Answers" class="img-circle if-not-collapsed" data-holder-rendered="true" height="93" src="/mabenefitsmailbox/Content/lmi/images/minus_icon.png" width="93" /></a> <h3><a data-parent="#detail-panel-group" data-target="#questions-detail-section" data-toggle="collapse">Questions &amp; Answers</a></h3><p>Answers to previously asked questions.</p></div><div class="col-lg-4 col-sm-12 text-center" id="resources"><a class="collapsed" data-parent="#detail-panel-group" data-target="#resources-detail-section" data-toggle="collapse"><img alt="Resources" class="img-circle if-collapsed" data-holder-rendered="true" height="93" src="/mabenefitsmailbox/Content/lmi/images/resources01.png" width="93" /><img alt="Resources" class="img-circle if-not-collapsed" data-holder-rendered="true" height="93" src="/mabenefitsmailbox/Content/lmi/images/minus_icon.png" width="93" /></a> <h3><a data-parent="#detail-panel-group" data-target="#resources-detail-section" data-toggle="collapse">Resources</a> </h3><p>Resources if your questions do not relate to Part C benefits policy.</p></div></div>

Guidance

CMS guidance documents related to Part C benefits policy.

Questions & Answers

Answers to previously asked questions.

Resources

Resources if your questions do not relate to Part C benefits policy.

Please review the available guidance documents and the resources below that may answer your question.

(Optional) Select a previous version:

<div id="detailsContainer"><div class="ma-details-row"><p><strong><em></em></strong><strong><em>Contract Year 2024</em></strong></p><p style="margin-left:30px;"><strong><em></em></strong><a href="/MABenefitsMailbox/S3Browser/GetFile?path=Final%20CY%202024%20Part%20C%20Bid%20Review%20Memo.pdf" target="_blank" title="Final Contract Year (CY) 2024 Standards for Part C Benefits, Bid Review, and Evaluation">Final Contract Year CY 2024 Standards for Part C Benefits, Bid Review, and Evaluation (04/14/2023)</a></p><p style="margin-left:30px;"><a href="/MABenefitsMailbox/S3Browser/GetFile?path=Total%20Beneficiary%20Cost%20Data%20for%20CY%202024%20Bid%20Preparation_04_20_2023.pdf" target="_blank" title="Total Beneficiary Cost Data for CY 2024 Bid Preparation (04/20/2023)">Total Beneficiary Cost Data for CY 2024 Bid Preparation (04/20/2023)</a></p><p style="margin-left:30px;"><a href="/MABenefitsMailbox/S3Browser/GetFile?path=Update%20Regarding%20CY%202024%20Part%20C%20Bid%20Review%20OOPC%20Model.pdf" target="_blank" title="Update Regarding CY 2024 Part C Bid Review OOPC Model">Update Regarding CY 2024 Part C Bid Review OOPC Model (05/16/2023)</a></p><p style="margin-left:30px;"><a href="/MABenefitsMailbox/S3Browser/GetFile?path=CY%202024%20Part%20C%20Bid%20Review%20OOPC%20Model.pdf">Update Regarding Contract Year 2024 Part C Bid Review Out-of-Pocket Cost Model (07/24/2023)</a></p><p style="margin-left:30px;"><a href="/MABenefitsMailbox/S3Browser/GetFile?path=IRA%20Part%20B%20Rebatable%20Drugs%20and%20Insulin%20FAQs.pdf">IRA Part B Rebatable Drugs and Insulin FAQs (07/13/2023)</a></p><p><em><strong><br />Recent Regulations</strong></em></p><ul style="list-style-type:none;"><li style="margin:10px 0;"><a href="/MABenefitsMailbox/S3Browser/GetFile?path=CY2023%20Part%20C%20IRA%20Memorandum%2011-7-2022.pdf" target="_blank">CY 2023 Part C IRA Memorandum (11/07/2022)</a></li><li style="margin:10px 0;"><a href="https://www.federalregister.gov/documents/2022/04/14/2022-07642/medicare-program-maximum-out-of-pocket-moop-limits-and-service-category-cost-sharing-standards" target="_blank">Contract Year 2023 Medicare Advantage Maximum Out-of-Pocket Limits and Service Category Cost Sharing Standards Final Rule with Comment Period (CMS-4190-FC4) (04/14/2022)</a></li><li style="margin:10px 0;"><a href="https://www.federalregister.gov/documents/2021/01/19/2021-00538/medicare-and-medicaid-programs-contract-year-2022-policy-and-technical-changes-to-the-medicare" target="_blank">Medicare and Medicaid Programs; Contract Year 2022 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicaid Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (CMS-4190-F2) (01/19/2021)</a></li><li style="margin:10px 0;"><a href="https://www.federalregister.gov/documents/2020/06/02/2020-11342/medicare-program-contract-year-2021-policy-and-technical-changes-to-the-medicare-advantage-program" target="_blank">Medicare Program; Contract Year 2021 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program (CMS-4190-F1) (06/02/20)</a></li></ul><p><strong><em><br />Contract Year 2023</em></strong></p><ul style="list-style-type:none;"><li style="margin:10px 0px;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=Medicare%20and%20You%202023.pdf">Medicare and You 2023</a></li><li style="margin:10px 0px;"><span class="ui-provider uh b c d e f g h i j k l m n o p q r s t u v w x y z ab ac ae af ag ah ai aj ak" dir="ltr"><a href="/MABenefitsMailbox/S3Browser/GetFile?path=CY2023%20Part%20C%20IRA%20Memorandum%2011-7-2022.pdf">CY 2023 Part C IRA Memorandum (11/07/2022)</a></span></li><li style="margin:10px 0px;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=Final%20CY%202023%20Part%20C%20Bid%20Review%20Eval%20Memorandum.pdf">Final Contract Year 2023 Part C Benefits Review and Evaluation (04/20/2022)</a><br /></li><li style="margin:10px 0px;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=Release%20of%20CY%202023%20Bid%20Review%20OOPC%20Model.pdf">Contract Year 2023 Bid Review Out-of-Pocket Cost Models (04/08/2022)</a></li><li style="margin:10px 0px;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=CY2023_PBP-BPT_Release_and_800-series_Memo_03232022_final.pdf">Release of the 2023 Plan Benefit Package and Bid Pricing Tool Software and Related Technical Bidding Guidance for Employer/Union-Only Group Waiver Plans (04/08/2022)</a></li><li style="margin:10px 0px;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=CY23%20D-SNP%20lookalike%20Transition%20HPMS%20Memo_Final.pdf">Dual Eligible Special Needs Plan &ldquo;Look-Alike&rdquo; Transitions for Contract Year 2023 (04/07/2022)</a></li><li style="margin:10px 0px;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=2023%20Rate%20Announcement%20FINAL_4.4.2022_508.pdf">Announcement of Calendar Year (CY) 2023 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (04/04/2022)</a></li><li style="margin:10px 0px;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=Updated%20CY%202022%20Part%20C%20and%20Part%20D%20Baseline%20OOPC%20Model%20Values.pdf">Updated CY 2022 Part C and Part D Baseline OOPC Model Values (02/07/2022)</a></li><li style="margin:10px 0px;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=CY%202022%20Part%20C%20and%20Part%20D%20Baseline%20OOPC%20Models.pdf">Contract Year 2022 Part C and Part D Baseline Out-of-Pocket Cost Models (12/30/2021)</a></li><li style="margin:10px 0px;"><a href="https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/preventive-services/medicare-wellness-visits.html" target="_blank">Medicare Wellness Visits (Initial Preventive Physical Exam and Annual Wellness Visit)</a></li></ul><p><br /><strong><em>Contract Year 2022</em></strong></p><ul style="list-style-type:none;"><li style="margin:10px 0;"><a href="https://www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf" target="_blank">Medicare and You 2022</a></li><li style="margin:10px 0;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=2022_FINAL%20CY%202022%20Part%20C%20Bid%20Review%20Memo.pdf" target="_blank">Final Contract Year 2022 Part C Benefits Review and Evaluation (05/20/2021)</a></li><li style="margin:10px 0;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=2022_CY%202022%20MA%20Bid%20Technical%20Inst%2005-12-2021.pdf" target="_blank">Contract Year 2022 Medicare Advantage Technical Instructions (05/12/2021)</a></li><li style="margin:10px 0;"><a href="https://www.cms.gov/files/document/addendum-2022-announcement.pdf" target="_blank">Addendum to Announcement of Calendar Year (CY) 2022 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies: List of Private Fee-for-Service Network Areas for 2023 (03/29/2021)</a></li><li style="margin:10px 0;"><a href="https://www.cms.gov/files/document/2022-announcement.pdf" target="_blank">Announcement of Calendar Year (CY) 2022 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (01/15/2021)</a></li></ul><p><em><strong><br />Other Reference Material</strong></em></p><ul style="list-style-type:none;"><li style="margin:10px 0;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=Supplemental%20Benefits%20for%20Chronically%20Ill%20Memo%20(April%2024%2C%202019).pdf" target="_blank">Implementing Supplemental Benefits for Chronically Ill Enrollees (04/24/2019)</a></li><li style="margin:10px 0;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=2020_HPMS%20Memo%20-%20Reinterpretation%20of%20the%20%20Uniformity%20Requirement%204-27-18.pdf" target="_blank">Reinterpretation of the Uniformity Requirement (04/27/2018)</a></li><li style="margin:10px 0;"><a href="https://askmarty2.lmi.org/MABenefitsMailbox/S3Browser/GetFile?path=2020_HPMS%20Memo%20Primarily%20Health%20Related%204-27-18.pdf" target="_blank">Reinterpretation of &ldquo;Primarily Health Related&rdquo; for Supplemental Benefits (04/27/2018)</a></li><li style="margin:10px 0;"><a href="http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS019326.html?DLPage=2&amp;DLSort=0&amp;DLSortDir=ascending" target="_blank">Medicare Managed Care Manuals</a></li><li style="margin:10px 0;"><a href="http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/OOPCResources.html" target="_blank">OOPC Resources</a></li></ul></div></div>

Contract Year 2024

Final Contract Year CY 2024 Standards for Part C Benefits, Bid Review, and Evaluation (04/14/2023)

Total Beneficiary Cost Data for CY 2024 Bid Preparation (04/20/2023)

Update Regarding CY 2024 Part C Bid Review OOPC Model (05/16/2023)

Update Regarding Contract Year 2024 Part C Bid Review Out-of-Pocket Cost Model (07/24/2023)

IRA Part B Rebatable Drugs and Insulin FAQs (07/13/2023)

Recent Regulations

Contract Year 2023

Contract Year 2022

Other Reference Material

Answers to previously asked questions

Frequently Asked Questions (April 2020)

Following are available resources if your questions do not relate to Part C benefits policy:

(Optional) Select a previous version:

<div id="detailsContainer"><div class="ma-details-row"><p>Questions specifically related to the Medicare FFS Average Sales Price (ASP) files may be directed to: <a href="mailto:Sec303ASPdata@cms.hhs.gov">Sec303ASPdata@cms.hhs.gov</a></p><div class="ma-details-row"><p>If your question is regarding the Inflation Reduction Act, please submit the question to:&nbsp;<a href="mailto:IRARebateandNegotiation@cms.hhs.gov">IRARebateandNegotiation@cms.hhs.gov</a>&nbsp;</p></div><div class="ma-details-row"><p>Policy related fiscal soundness questions, please submit an e-mail to:&nbsp;<a href="mailto:FinancialReview@cms.hhs.gov&gt;FinancialReview@cms.hhs.gov&lt;/a&gt; &lt;/p&gt; &lt;p&gt;Technical HPMS questions (e.g., PBP download, plan creation, bid upload), please contact the HPMS Help Desk at 1-800-220-2028 or &lt;a href=">FinancialReview@cms.hhs.gov</a></p></div><div class="ma-details-row"><p>Technical questions about the Out-of-Pocket Cost (OOPC) model, please submit an email to:&nbsp;<a href="mailto:OOPC@cms.hhs.gov?subject=Technical OOPC questions">OOPC@cms.hhs.gov</a> </p></div><div class="ma-details-row"><p>Part D benefits questions, please submit an email to:&nbsp;<a href="mailto:partdbenefits@cms.hhs.gov?subject=Part D Benefit question">partdbenefits@cms.hhs.gov</a><br /></p></div><div class="ma-details-row"><p>Bid Pricing Tool (BPT) questions, please submit an email to:&nbsp;<a href="mailto:actuarial-bids@cms.hhs.gov">actuarial-bids@cms.hhs.gov</a></p></div><div class="ma-details-row"><p>Medicare Medicaid Program,&nbsp;please submit an email to:&nbsp;<a href="mailto:mmcocapsmodel@cms.hhs.gov">mmcocapsmodel@cms.hhs.gov</a></p></div><div class="ma-details-row"><p>Part C Medicare Advantage policy questions, please submit an inquiry via:&nbsp;<a href="https://dpap.lmi.org/DPAPMailbox/">https://dpap.lmi.org/DPAPMailbox/</a> <a href="https://dpap.lmi.org/DPAPMailbox/"></a></p></div><div class="ma-details-row"><p>Medicare Advantage Value-Based Insurance Design (MA-VBID) model questions, please submit an e-mail to:&nbsp;<a href="mailto:VBID@cms.hhs.gov">VBID@cms.hhs.gov</a></p></div><div class="ma-details-row"><p>Appeals Policy questions, please submit inquiry via: <a href="https://appeals.lmi.org/" target="_blank" title="https://appeals.lmi.org/">https://appeals.lmi.org/</a></p></div><div class="ma-details-row"><p>Enrollment and Eligibility Policy questions, please submit inquiry via: <a href="https://enrollment.lmi.org/" tabindex="-1" target="_blank" title="https://enrollment.lmi.org"><span>https://enrollment.lmi.org</span></a></p></div></div></div>

Questions specifically related to the Medicare FFS Average Sales Price (ASP) files may be directed to: Sec303ASPdata@cms.hhs.gov

If your question is regarding the Inflation Reduction Act, please submit the question to: IRARebateandNegotiation@cms.hhs.gov

Policy related fiscal soundness questions, please submit an e-mail to: FinancialReview@cms.hhs.gov

Technical questions about the Out-of-Pocket Cost (OOPC) model, please submit an email to: OOPC@cms.hhs.gov

Part D benefits questions, please submit an email to: partdbenefits@cms.hhs.gov

Bid Pricing Tool (BPT) questions, please submit an email to: actuarial-bids@cms.hhs.gov

Medicare Medicaid Program, please submit an email to: mmcocapsmodel@cms.hhs.gov

Part C Medicare Advantage policy questions, please submit an inquiry via: https://dpap.lmi.org/DPAPMailbox/

Medicare Advantage Value-Based Insurance Design (MA-VBID) model questions, please submit an e-mail to: VBID@cms.hhs.gov

Appeals Policy questions, please submit inquiry via: https://appeals.lmi.org/

Enrollment and Eligibility Policy questions, please submit inquiry via: https://enrollment.lmi.org

Ask a Part C Benefits Question

Please review the available guidance documents and resources described above before submitting a question.