US · guidance
CMS Pub. 100-16, ch. 9, § 40.1
Coverage throughout the State
If an MAO provides coverage to individuals in any part of a State, CMS is waiving the
requirement that the Individual Employer Group Health Plans and EGWPs have the same service
area. Accordingly, under this waiver, an MAO offering an individual MA plan in a state can
offer an EGWP (of the same plan type) in any area within that State or throughout the entire
State (provided the EGWP service area is properly requested and defined in HPMS). For Part C
benefits, the MAO is responsible for ensuring that CMS provider network adequacy
requirements are met and that consistent benefits are provided to the employer/union group plan
sponsor’s enrollees.
History
(Rev. 111, 05-03-13, Effective: 05-03-13, Implementation: 05-03-13)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
6831ee523fc907668c6a453b1f3ee108a98b11fe588a8a0e80323fcd944a533c
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.