GroundRules
42 CFR 417.481: Maintenance of records: Risk HMOs and CMPs.
Where this section sits in the code
- Title 42—Public Health
- 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 L—Medicare Contract Requirements
A risk contract must provide that the HMO or CMP agrees to maintain and make available to CMS upon request, books, records, documents, and other evidence of acounting procedures and practices that—
(a) Are sufficient to—
(1) Establish component rates of the ACR for determining additional and supplementary benefits; and
(2) Determine the rates utilized in setting premiums for State insurance agency purposes; and
(b) Include at least any records or financial reports filed with other Federal agencies or State authorities.
Collected 2026-08-27T02:26:11Z. Source file · JSON