CMS-R-262 MTMP CY2022 Mockups

The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs) (CMS-R-262)

Appendix_C_MTMP2023_Mockups_09282021

CY2023 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)

OMB: 0938-0763

Document [pdf]
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Mockups
1.

CY 2022 MTMP – Enter/Edit - Program Information Page - Removed following text and
combined the sections:
- Data Evaluated to Identify Beneficiary as At-Risk (Select one or more options):
- Data Evaluated to Identify Chronic Conditions (Select one or more options):

2. CY 2022 MTMP – Enter/Edit – Multiple Covered Part D Drugs Page - Removed following text:
-

Data Evaluated to Identify the Number of Covered Part D Drugs (Select one or more
options):

3. CY 2022 MTMP – Enter/Edit – Targeting Page
-

Drug claims check box is checked and disabled.


File Typeapplication/pdf
File TitleMTMP Mockups for PRA
AuthorPuvvada, Himadhar
File Modified2021-09-28
File Created2021-09-28

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