US · guidance
CMS Pub. 100-16, ch. 8, § 140.3
Only the MA Organization is Entitled to Payment
Per 42 CFR 422.322(c), only the MA organization is entitled to receive payment from
CMS under title XVIII of the Act for items and services furnished to the individual. This
statement is subject to provisions set forth in the MA regulations:
• 422.314 on special rules for beneficiaries enrolled in MA MSA plans;
• 422.318 on special rules for coverage that begins or ends during an inpatient
hospital stay;
• 422.320 on special rules for hospice care; and
• 422.520 detailing the MA prompt payment provisions specifying conditions under
which CMS may make direct payments to providers or MA private-fee-for service
plan enrollees.
This statement is also subject to the following provisions of the Act: §1886(d) concerning
additional payment amounts to any subsection (d) hospital with an approved medical
residency training program for applicable discharges of MA enrollees; and §1886(h)(3)(D)
concerning calculations of payments to hospitals for direct graduate medical education
costs.
History
(Rev. 89; Issued: 11-02-07; Effective/Implementation: 11-02-07)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
ab649ede0cd96fa983fc8e1a294d7bffbd7a32662bf229ef739db74f08120c72
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.