CMS Pub. 100-16, ch. mc86c16a, § 30.2

42 CFR 422.114(a)(2)(ii)(A)

As discussed in section 30.1 of this chapter, a PFFS plan can meet the access to services

requirement with respect to a particular category of health care providers by establishing

signed contracts or agreements with a sufficient number and range of providers to meet

the access standards described in section 1852(d)(1) of the Act. Section 1852(d)(1) of the

Act describes the requirements that MA organizations offering a coordinated care plan

(CCP) must meet when selecting providers to furnish benefits covered under the plan.

The access standards for CCPs are described in 42 CFR 422.112(a) and section 110.1 of

Chapter 4 of this manual.

Full and partial (only for the categories of providers for which the plan is using a network

of providers with signed contracts or agreements with the plan) network PFFS plans are

required to meet the same access standards as CCPs. Providers with signed contracts or

agreements with the plan are also known as direct-contracting providers or network

providers. CMS reviewers follow the same procedure when reviewing the Health Service

Delivery (HSD) Tables for initial and service area expansion applications for coordinated

care, PFFS, and network MSA plans in order to determine whether an MA organization’s

proposed network meets the access standards. Full and partial network plans must submit

information about their proposed provider networks to CMS. CMS reviews that

information as part of the application approval process to ensure that timely, accessible,

and appropriate care is provided.