Relevant to: State Medicare-Medicaid Plan Handbooks, Marketing Guidance

Introduction

The Centers for Medicare & Medicaid Services has unveiled an updated Chapter 4 of the Member Handbook for Medicare-Medicaid Plans (MMPs) specific to Michigan, replacing the previously issued version for Contract Year 2025. Among the key changes is an increase in authorized doula visits from 9 to 12. Michigan MMPs are required to inform enrollees about these updates in compliance with the “Mid-Year Change Notification to Enrollees” instructions within the 2025 Marketing Guidance.

Key Dates and Deadlines

• Memo Date: December 12, 2024
• Contract Year 2025 Marketing Guidance Issuance Date: August 8, 2024

PACE Compliance

This memo is relevant to PACE programs as it involves updates to the marketing model and member handbook for Medicare-Medicaid Plans operating under the Michigan capitated financial alignment model demonstration. Such updates may have implications for PACE compliance, particularly in the manner by which changes are communicated to enrollees.

Pace programs should:

• Ensure that any changes in services or coverage are communicated to enrollees as per the CMS guidance specified in the memo, avoiding the errata process.
• Follow the “Mid-Year Change Notification to Enrollees” instructions found in the CY 2025 Marketing Guidance for Michigan Medicare-Medicaid Plans, specifically section 422.2267(e), to maintain compliance.
• Monitor communications from CMS for further updates or changes to guidelines that could impact compliance.
• Verify that revisions in marketing materials and handbooks are accurate and correctly implemented.

Non-compliance with these requirements could result in potential penalties or miscommunication with enrollees, which PACE programs must proactively prevent.

Required Actions

CONTENT TO USE FOR GENERATION: [Link] http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/MMPInformationandGuidance/MMPMarketingInformationandResources [Link] http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/MMPInformationandGuidance/MMPMarketingInformationandResources [Link] http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/MMPInformationandGuidance/MMPMarketingInformationandResources [Link] http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/MMPInformationandGuidance/MMPMarketingInformationandResources [Link] mailto:MMCOCapsModel@cms.hhs.gov DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 21244-1850 MEDICARE-MEDICAID COORDINATION OFFICE DATE: December 12, 2024 TO: Michigan Medicare-Medicaid Plans FROM: Lindsay P. Barnette Director, Models, Demonstrations & Analysis Group SUBJECT: Release of Revised Contract Year 2025 Marketing Model Accompanying this memorandum is an updated version of Chapter 4 of the Member Handbook for Medicare-Medicaid Plans (MMPs) for Contract Year (CY) 2025 developed jointly by CMS and the state of Michigan for MMPs operating in the Michigan capitated financial alignment model demonstration. This model replaces the model previously issued for CY 2025. The marketing model updates include: Member Handbook (Evidence of Coverage): Chapter 4, Page 20 – updated the number of doula visits from 9 to 12. Michigan MMPs must communicate these revisions to enrollees in accordance with the “Mid-Year Change Notification to Enrollees” instructions in the “CMS required materials and content (422.2267(e))” section in the CY 2025 Marketing Guidance for Michigan Medicare-Medicaid Plans, issued on August 8, 2024. Michigan MMPs must not use the errata process to communicate these changes. We will post the revised models on the Medicare-Medicaid Coordination Office’s Information and Guidance for Plans webpage at www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and- Medicaid-Coordination/Medicare-Medicaid-Coordination- Office/FinancialAlignmentInitiative/MMPInformationandGuidance/MMPMarketingInformationand Resources, grouped alphabetically by state under the “State-Specific Information” heading. If you have any questions about the contents of this memorandum, please contact the Medicare- Medicaid Coordination Office at MMCOCapsModel@cms.hhs.gov.

FAQs

• “What changes have been made to the Medicare-Medicaid Plans for 2025?”
• “How many doula visits are covered under the updated member handbook?”
• “What is the correct procedure for Michigan MMPs to notify enrollees about mid-year changes?”
• “Where can I find the revised models for the Michigan MMPs?”

Click here to read the complete memo from CMS.

Disclaimer: The content provided on this page is a summary for informational purposes only. It does not constitute legal or regulatory advice, nor does it replace the original CMS memo. Readers are advised to consult the full CMS memo in its entirety to ensure comprehensive understanding and compliance before making any changes or taking action based on this information.