US · guidance
CMS Pub. 100-16, ch. 4, § 100.4
Valuing Rewards and Incentives
Rewards and incentives for each RI Program must have values that are expected to elicit
intended enrollee behavior but may not exceed the value of the health related service or
activity (§422.134(C)(1)(iii)).
At this time, CMS has not identified the monetary values that exceed what is necessary to
influence enrollee behavior. There is also no express limit on how often rewards and/or
incentives may be offered to enrollees throughout a contract year. Instead, MA plans are
to establish reasonable and appropriate values for rewards and/or incentives that comply
with §422.134.
If necessary, in the future, we may issue additional guidance applying the regulation
standards to specify limits on the value of rewards and incentives.
History
(Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
50264de028a02bb533f41e6bc9dfb5a0e163fab0e58dbbd6f5526c2fce8eadae
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