US · guidance
CMS Pub. 100-16, ch. mc86c16a, § 70.2.3
Payment Rules for Direct-Contracting Providers
• The plan may establish payment rates for direct-contracting providers that are
different than the rates established in the terms and conditions of payment for
deemed providers.
• Since the plan meets the access to services requirement by paying all providers at
least the Original Medicare rates or higher, direct-contracting providers must also
be paid at least the Original Medicare rates or higher.
• The payment rates for direct-contracting providers must be established in the
signed contract or agreement between the plan and the provider.
• The payment rates can be provider-specific, and public disclosure of the rates is
not required.
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
871434cd9cafd4e899ee080f7e246e03c2fa27bc846e63f72b3aaac719fffb06
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