C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 417—HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS › Subpart J—Qualifying Conditions for Medicare Contracts

42 C.F.R. § 417.400

Basis and scope

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(a) Statutory basis. The regulations in this subpart implement section 1876 of the Act, which authorizes Medicare payment to HMOs and CMPs that contract with CMS to furnish covered services to Medicare beneficiaries.

(b) Scope. (1) This subpart sets forth the requirements an HMO or CMP must meet in order to enter into a contract with CMS under section 1876 of the Act. It also specifies the procedures that CMS follows to evaluate applications and make determinations.

(2) The rules for payment to HMOs and CMPs are set forth in subparts N, O, and P of this part.

(3) The rules for HCPP participation in Medicare under section 1833(a)(1)(A) of the Act are set forth in subpart U of this part.

[60 FR 45675, Sept. 1, 1995]
Notes of Decisions
Cited in 1 case, 1992–1992 · leading case: Lutheran Med. Ctr. v. Elderplan, Inc., 155 Misc. 2d 887 (N.Y. City Civ. Ct. 1992).
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Lutheran Med. Ctr. v. Elderplan, Inc., 155 Misc. 2d 887 (N.Y. City Civ. Ct. 1992). “Thus the Federal Government has authorized reimbursement to HMOs for furnishing covered services to Medicare beneficiaries (42 CFR 417.400). The marketing activities of HMOs are prescribed by section 417.”
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