42 C.F.R. § 422.110

Discrimination against beneficiaries prohibited

Read at: eCFRecfr.gov CornellLII GovInfogovinfo.gov CasesGoogle Scholar

(a) General prohibition. Except as provided in paragraph (b) of this section, an MA organization may not deny, limit, or condition the coverage or furnishing of benefits to individuals eligible to enroll in an MA plan offered by the organization on the basis of any factor that is related to health status, including, but not limited to the following:

(1) Medical condition, including mental as well as physical illness.

(2) Claims experience.

(3) Receipt of health care.

(4) Medical history.

(5) Genetic information.

(6) Evidence of insurability, including conditions arising out of acts of domestic violence.

(7) Disability.

(b) Exception. For coverage before January 1, 2021, an MA organization may not enroll an individual who has been medically determined to have end-stage renal disease. However, an enrollee who develops end-stage renal disease while enrolled in a particular MA organization may not be disenrolled for that reason. An individual who is an enrollee of a particular MA organization, and who resides in the MA plan service area at the time he or she first becomes MA eligible, or, an individual enrolled by an MA organization that allows those who reside outside its MA service area to enroll in an MA plan as set forth at § 422.50(a)(3)(ii), then that individual is considered to be “enrolled” in the MA organization for purposes of the preceding sentence.

[63 FR 35077, June 26, 1998; 63 FR 52612, Oct. 1, 1998; 64 FR 7980, Feb. 17, 1999, as amended at 65 FR 40321, June 29, 2000; 70 FR 4721, Jan. 28, 2005; 85 FR 33904, June 2, 2020]
Notes of Decisions
Cited in 2 cases (2 in the last 5 years), 2024–2024 · leading case: Hosp. Amerimed Cancun S a De C v. v. Martins Point Health Care Inc (D. Me. 2024).
Hosp. Amerimed Cancun S a De C v. v. Martins Point Health Care Inc (D. Me. 2024). · cites it 2× “42 C.F.R. §§ 422.110 (c)(2), 422.102(c). Although “CMS generally has little say over the package of supplemental benefits that a plan chooses to offer,” MAOs’ plans are subject to a battery of rules and standards and CMS must approve all supplemental benefits included in a plan…”
Hosp. Quirurgica Del Sur v. Martins Point Health Care Inc (D. Me. 2024). · cites it 2× “42 C.F.R. §§ 422.110 (c)(2), 422.102(c). Although “CMS generally has little say over the package of supplemental benefits that a plan chooses to offer,” MAOs’ plans are subject to a battery of rules and standards and CMS must approve all supplemental benefits included in a plan…”
Annotations are extracted automatically from the opinions in the Syfert caselaw corpus and ranked by authority, recency, and treatment. Dots show Syfertize treatment of the citing case itself.