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 O—Medicare Payment: Cost Basis

42 C.F.R. § 417.530

Basis and scope

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This subpart sets forth the principles that CMS follows to determine the amount it pays for services furnished by a cost HMO or CMP to its Medicare enrollees. These principles are based on sections 1861(v) and 1876 of the Act and are, for the most part, the same as those set forth—

(a) In part 412 of this chapter, for paying the costs of inpatient hospital services which, for cost HMOs and CMPs, are considered “reasonable” only if they do not exceed the amounts allowed under the prospective payment system; and

(b) In part 413 of this chapter, for the costs of all other covered services.

[60 FR 46230, Sept. 6, 1995]
Notes of Decisions
Cited in 2 cases, 2000–2011 · leading case: Ne. Hosp. Corp. v. Sebelius, 657 F.3d 1 (D.C. Cir. 2011).
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Ne. Hosp. Corp. v. Sebelius, 657 F.3d 1 (D.C. Cir. 2011). · cites it 2× “§ 1395mm(a), (g), (h); see also 42 C.F.R. §§ 417.530 -.576 (cost contracts), 417.”
Minnesota Ex Rel. Hatch v. United States, 102 F. Supp. 2d 1115 (D. Minnesota 2000). “§ 1395mm(a), (g), (h); see also 42 C.F.R. §§ 417.530 -.576 (cost contract); id.”
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