US · guidance
CMS Pub. 100-16, ch. mc86c16a, § 40.1
Direct-Contracting Providers
A provider is a direct-contracting provider if the provider has a signed contract or
agreement with a PFFS plan to deliver covered services to the plan’s members. These
providers are also known as network providers. Direct-contracting providers have
already agreed to see members of the plan.
• Full network PFFS plans must establish direct-contracting providers for all
categories of Part A and Part B services in accordance with the access standards
described in section 1852(d)(1) of the Act and section 30.2 of this chapter.
• Partial network PFFS plans may have direct-contracting providers for one or more
categories of Part A or Part B services in accordance with the access standards
described in section 1852(d)(1) of the Act and section 30.2 of this chapter.
• Non-network PFFS plans generally do not have direct-contracting providers.
However, non-network plans may establish signed contracts or agreements with
some providers without meeting the access standards described in section
1852(d)(1) of the Act and section 30.2 of this chapter.
The payment rules for direct-contracting providers under the three types of PFFS plans
are discussed in section 70 of this chapter.
History
(Rev. 99, Issued: 05-27-11, Effective: 05-27-11, Implementation: 05-27-11)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
7bb4abe79bc5e2775e6d44c7b59fa3c8da3d19ce273ad1421f5164716c5a2818
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