{"data":{"id":"us/42-cfr-422.352","jurisdiction":"us","citation":"42 CFR 422.352","heading":"Basic requirements.","body":"(a) General rule. An organization is considered a PSO for purposes of a MA contract if the organization—\n(1) Has obtained a waiver of State licensure as provided for under § 422.370;\n(2) Meets the definition of a PSO set forth in § 422.350 and other applicable requirements of this subpart; and\n(3) Is effectively controlled by the provider or, in the case of a group, by one or more of the affiliated providers that established and operate the PSO.\n(b) Provision of services. A PSO must demonstrate to CMS's satisfaction that it is capable of delivering to Medicare enrollees the range of services required under a contract with CMS. Each PSO must deliver a substantial proportion of those services directly through the provider or the affiliated providers responsible for operating the PSO. Substantial proportion means—\n(1) For a non-rural PSO, not less than 70% of Medicare services covered under the contract.\n(2) For a rural PSO, not less than 60% of Medicare services covered under the contract.\n(c) Rural PSO. To qualify as a rural PSO, a PSO must—\n(1) Demonstrate to CMS that—\n(i) It has available in the rural area, as defined in § 412.62(f) of this chapter, routine services including but not limited to primary care, routine specialty care, and emergency services; and\n(ii) The level of use of providers outside the rural area is consistent with general referral patterns for the area; and\n(2) Enroll Medicare beneficiaries, the majority of which reside in the rural area the PSO serves.","path":["Title 42—Public Health","CHAPTER IV—CENTERS FOR MEDICARE \u0026 MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES","SUBCHAPTER B—MEDICARE PROGRAM","PART 422—MEDICARE ADVANTAGE PROGRAM","Subpart H—Provider-Sponsored Organizations"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-42.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:11Z","sha256":"aae62af8c42f384f6f530c2cdeed69634e85bdf73113aedb11f0f8c87691e25b","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-422.350","next":"us/42-cfr-422.354"},"notice":"GroundRules: Original legal text. Not legal advice."}