Form CMS-10261 Attachment I - Part C Reporting Overview

Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516 (a)

Attachment I.9.23.08

Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516 (a) - (CMS-10261)

OMB: 0938-1054

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Attachment I: Part C Reporting Overview

Measure

Type Plans Required to Report

Report Freq./

Level

Report

Period (s)

Data Due date (s)

1. Benefit Utilization

CCP, PFFS, Demo, MSA, SNPs (includes all 800 series plans), Employer/Union Direct Contract

1/year

PBP

1/1-12/31

8/31 of the following year.

2. Procedure Frequency

CCP, PFFS, Demo, MSA (includes all 800 series plans) , Employer/Union Direct Contract

1/year

Contract

1/1-12/31

5/31 of following year

3. Serious Reportable Adverse Events

CCP, PFFS, Demo, MSA (includes all 800 series plans) , Employer/Union Direct Contract

1/year

Contract

1/1-12/31

5/31 of following year

4. Provider Network Adequacy

CCP, 1876 Cost, Demo (includes all 800 series plans)

1/year

Contract

1/1 -12/31

2/28 of following year

5. Grievances

CCP, PFFS, 1876 Cost, Demo, MSA (includes all 800 series plans) , Employer/Union Direct Contract

4/Year

Contract

1/1-3/31

4/1-6/30

7/1-9/30

10/1-12/31

5/31

8/31

11/30

2/28 of following year

6. Organization Determinations/

Reconsiderations

CCP, PFFS, 1876 Cost, Demo, MSA (includes all 800 series plans) , Employer/Union Direct Contract


4/Year

Contract

1/1-3/31

4/1-6/30

7/1-9/30

10/1-12/31

5/31

8/31

11/30

2/28 of following year

7. Employer Group Plan Sponsors

CCP, PFFS, 1876 Cost, Demo, MSA (includes sponsors of individual plans and 800 series plans)


2/year

PBP

1/1 -6/30

7/1-12/31

8/31

2/28 of following year

8. PFFS Plan Enrollment Verification Calls

PFFS

1/year

PBP

1/1-12/31

2/28 of following year

9. PFFS Provider Payment Dispute Resolution Process

PFFS (includes all 800 series plans) , Employer/Union Direct Contract


1/year

PBP

1/1-12/31

2/28 of following year

10. Agent Commission Structure

CCP, PFFS, 1876 Cost, Demo, MSA (includes all 800 series plans)


1/year

Contract

1/1-12/31

2/28 of following year

11. Agent Training and Testing

CCP, PFFS, 1876 Cost, Demo, MSA

1/year

Contract

1/1-12/31

2/28 of following year

12. Plan Oversight of Agents

CCP, PFFS, 1876 Cost, Demo, MSA (includes all 800 series plans)


4/Year

Contract

1/1-3/31

4/1-6/30

7/1-9/30

10/1-12/31

5/31

8/31

11/30

2/28 of following year

13. SNPS Care Management

SNPs (includes all 800 series plans)


1/Year/PBP

1/1-12/31

5/31 of following year



Note: For #4, Employer/Union Direct Contracts are not included since they currently only offer PFFS plans. If, at a later date, PFFS plans are required to report on this measure and/or Direct Contracts are allowed to offer other kinds of MA plans, they should be required to report on this measure as well.

File Typeapplication/msword
File TitleAttachment I: Part C Reporting Requirements Summary Chart
AuthorCMS
Last Modified ByCMS
File Modified2008-09-23
File Created2008-09-23

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