CMS Pub. 100-16, ch. mc86c16a, § 50.3

Payment

(Rev. 99, Issued: 05-27-11, Effective: 05-27-11, Implementation: 05-27-11)

All terms and conditions of payment must be reviewed and approved by the appropriate

CMS RO account manager prior to use by PFFS plans. Plans must update their terms and

conditions of payment annually to reflect changes in their plan benefit packages. The

updated terms and conditions of payment must be submitted to the plan’s RO account

manager for review and approval. Plans may not use a terms and conditions of payment

without prior approval by CMS. Similarly, plans may not change the contents of the

terms and conditions of payment during the year without CMS approval.

PFFS plans should submit their terms and conditions of payment to their RO account

manager via email. Although the terms and conditions of payment do not meet the

definition of marketing material, as defined in section 20 of Chapter 3 of this manual,

CMS will follow the standard 10-day review process described in section 90.5 of Chapter

3 of this manual for the review and approval of the terms and conditions of payment

when a plan uses the model provided by CMS. The 10-day period begins on the date on

which the terms and conditions of payment are received by the RO account manager.