US · guidance
CMS Pub. 100-16, ch. 14, § 10
Contract Determinations
Subpart N of part 42 provides procedures for making and reviewing the following MA
contract determinations:
• A determination by CMS that an entity is not qualified to enter into an MA
contract with CMS;
• A determination by CMS that an entity is not qualified to offer a Special Needs
Plan (SNP);
• A determination by CMS that an entity is not qualified to complete a Service Area
Expansion (SAE);
• A determination by CMS to terminate a contract with an MA organization
(MAO); and
• A determination by CMS not to authorize a renewal of a contract with a MAO.
Note that SAE determinations are subject to the procedures for making and reviewing
MA contract determinations because, at this time, CMS treats SAE applications as new
MA contract applications for the newly added areas and they are therefore subject to the
same approval standards.
History
(Rev. 122, Issued: 05-27-16, Effective: 06-28-16, Implementation: 06-28-16)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
d68674a5377def39642a81f66bee6adbded4e0a025f0996da3b5f16780cdf47f
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