US · guidance
CMS Pub. 100-16, ch. 9, § 60.2
Financial Solvency
An MAO generally must be licensed as a risk-bearing entity eligible to offer health insurance or
health benefits coverage under State law. (See 42 CFR 422.400(a).) CMS waived the licensure
requirement for employer/union direct contract MAOs that provide coverage to their own
members pursuant to its waiver authority. However, as a condition of this waiver, CMS requires
that these entities meet certain financial solvency standards. CMS requires that the entity
demonstrate that its fiscal soundness is commensurate with its financial risk, and that through
other means, the entity can assure that claims for benefits paid for by CMS and beneficiaries will
be covered.
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
6441a932a85f847e2b8473dd6e418011569c0304e8503862ec86f54dd30b871a
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