C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 422—MEDICARE ADVANTAGE PROGRAM › Subpart K—Application Procedures and Contracts for Medicare Advantage Organizations

42 C.F.R. § 422.527

Agreements with Federally qualified health centers

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The contract between the MA organization and CMS must specify that—

(a) The MA organization must pay a Federally qualified health center (FQHC) a similar amount to what it pays other providers for similar services.

(b) Under such a contract, the FQHC must accept this payment as payment in full, except for allowable cost sharing which it may collect.

(c) Financial incentives, such as risk pool payments or bonuses, and financial withholdings are not considered in determining the payments made by CMS under § 422.316(a).

[70 FR 4738, Jan. 28, 2005]
Notes of Decisions
Cited in 1 case, 2018–2018 · leading case: Cares Cmty. Health v. U.S. Dep't of Health & Human Servs., 346 F. Supp. 3d 121 (D.C. Cir. 2018).
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Cares Cmty. Health v. U.S. Dep't of Health & Human Servs., 346 F. Supp. 3d 121 (D.C. Cir. 2018). “" 42 C.F.R. § 422.527 (a). The dispute centers on whether this provision also applies to Part D prescription drugs.”
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