GENERAL INFORMATION....................................................... 5
1.1. Overview ............................................................................................................. 5
1.2. Types of MA Products......................................................................................... 5
1.3. Important References........................................................................................... 5
1.4. Technical Support................................................................................................ 6
1.5. The Health Plan Management System (HPMS) .................................................. 6
1.6. Submitting Notice of Intent to Apply (NOIA) .................................................... 7
1.7. Additional Information ........................................................................................ 8
1.8. Due Dates for Applications – Medicare Advantage and Medicare Cost Plans. 10
1.9. Request to Modify a Pending Application......................................................... 10
1.10. Application Determination and Appeal Rights.................................................. 11
INSTRUCTIONS ........................................................................ 11
2.1. Overview ........................................................................................................... 11
2.2. Applicants Seeking to Offer New Employer/Union-Only Group Waiver Plans
(EGWPs) ........................................................................................................... 12
2.3. Applicants Seeking to Offer Employer/Union Direct Contract MAO............... 12
2.4. Applicants Seeking to Offer Special Needs Plans (SNPs) ................................ 13
2.5. Applicants Seeking to Offer New MA D-SNP Look-Alike Plans..................... 14
2.6. Applicants Seeking to Expand Medicare Cost Plans......................................... 15
2.7. Applicants Seeking to Serve Partial Counties ................................................... 14
2.8. Types of Applications........................................................................................ 14
2.9. Chart of Required Attestations by Type of Applicant ....................................... 15
2.10. Document (Upload) Submission Instructions.................................................... 17
2.11. MA Part D (MA-PD) Prescription Drug Benefit Instructions ........................... 17
ATTESTATIONS ....................................................................... 18
3.1. Management, Experience, and History.............................................................. 20
3.2. Administrative Management ............................................................................. 20
3.3. State Licensure .................................................................................................. 21
3.4. Program Integrity............................................................................................... 23
3.5. Fiscal Soundness................................................................................................ 23
3.6. Service Area ...................................................................................................... 24
3.7. CMS Provider Participation Contracts & Agreements ...................................... 28
3.8. Contracts for Administrative & Management Services..................................... 28
3.9. Quality Improvement Program .......................................................................... 29
3.10. Marketing .......................................................................................................... 30
3.11. Eligibility, Enrollment, and Disenrollment........................................................ 31
3.12. Working Aged Membership .............................................................................. 32
3.13. Claims................................................................................................................ 33
3.14. Communications between MAO and CMS....................................................... 34
3.15. Grievances ......................................................................................................... 36
3.16. Organization Determination and Appeals ......................................................... 37
CY 2025 Part C Application