Application and determination.

  1. Law
  2. CFR 42
  3. Public Health
  4. Centers for Medicare & Medicaid Services, Department of Health and Human Services
  5. Medicare Program
  6. Health Maintenance Organizations, Competitive Medical Plans, and Health Care Prepayment Plans
  7. Qualifying Conditions for Medicare Contracts
  8. Application and determination.

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§ 417.406 Application and determination.

(a) Responsibility for making determinations. CMS is responsible for determining whether an entity meets the requirements to be an HMO or CMP.

(b) Application requirements.

(1) The application requirements for HMOs are set forth in § 417.143.

(2) The requirements of § 417.143 also apply to CMPs except that there are no application fees.

(c) Determination. CMS uses the procedures set forth in § 417.144(a) through (d) to determine whether an entity is an HMO or CMP.

(d) Oversight of continuing compliance.

(1) CMS oversees an entity's continued compliance with the requirements for an HMO as defined in § 417.1 or for a CMP as set forth in § 417.407.

(2) If an entity no longer meets those requirements, CMS terminates the contract of that entity in accordance with § 417.494.

[60 FR 45675, Sept. 1, 1995]


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