US · guidance
CMS Pub. 100-16, ch. 11, § 30
Minimum Enrollment Requirements for MA Organizations
Unless an organization has a minimum enrollment waiver as explained below, CMS does
not enter into a contract with an entity unless it meets the following minimum enrollment
requirements:
• At least 5,000 individuals (or 1,500 individuals if the organization is a PSO) are
enrolled for the purpose of receiving health benefits from the organization; or
• At least 1,500 individuals (or 500 individuals if the organization is a PSO) are
enrolled for purposes of receiving health benefits from the organization and the
organization primarily serves individuals residing outside of urbanized areas as
defined in 42 CFR §412.62(f) (or, in the case of a PSO, the PSO meets the
requirements at 42 CFR §422.352(c)).
Except when an organization has a minimum enrollment waiver, the organization must
maintain the minimum enrollment standards above for the duration of its contract.
History
(Rev. 79, Issued 02-17-06, Effective Date 02-17-06)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
758b43d0ae7c2e3331368d35e8fcab50d36d7adfc3762a15ce86b60f533d4144
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