US · guidance
CMS Pub. 100-16, ch. 6, § 30
Written Information on Physician Participation
An MA organization that operates a coordinated care plan or network Medical Saving
Account (MSA) plan must provide for the participation of individual physicians and the
management and members of groups of physicians, through reasonable procedures that
include:
1. Written notice of rules of participation including terms of payment, credentialing,
and other rules directly related to participation decisions;
2. Written notice of material changes in participation rules before the changes are put
into effect; and
3. Written notice of adverse participation decisions and a process for appeal (see
§60.4).
An MA organization that operates an MA plan through subcontracted physician groups
must provide that these participation procedures apply equally to physicians within those
subcontracted groups.
(Source: 42 CFR 422.202(a) and (c))
History
(Rev. 24, 06-06-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
da186fd8a874576b8b0f4e85fb60350225af69bb878a4a2b1b1b7c443073421e
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