CMS Pub. 100-16, ch. 1, § 20.2

As defined at 42 CFR 422.4(a)(1), a CCP is a plan that includes a network of providers

that are under contract or arrangement with the MA organization to deliver the benefit

package approved by CMS. A CCP must at least (i) furnish all Part A and Part B services

(except for hospice) (42 CFR 422.101(a)); (ii) conduct quality improvement activities (42

CFR 422.152(a)–(b)); (iii) provide sufficient access, as defined by CMS, to services

including continuity of care (42 CFR 422.112(a)–(b)); and (iv) disclose required

information about benefits and costs to enrollees (42 CFR 422.111(b)(2)).

CCPs may use mechanisms to control enrollee utilization of services. Mechanisms may

include requiring referrals from a gatekeeper (usually the enrollee’s primary care provider

(PCP)) or prior authorization for an enrollee to receive certain covered services (42 CFR

422.4(a)(1)(ii)).