US · guidance
CMS Pub. 100-16, ch. mc86c16a, § 70.3.1
General Rules
• The plan must meet the access to services requirement by establishing signed
contracts or agreements with a sufficient number and range of providers that meet
the access standards described in section 1852(d)(1) of the Act and section 30.2 of
this chapter.
• The plan must operate a network of direct-contracting providers (also known as
network providers) for all categories of Part A and Part B services.
• This access method is required for a plan that establishes payment rates for all
categories of Part A and Part B services that are less than the rates paid under
Original Medicare.
• As discussed in sections 30.3 and 30.4 of this chapter, beginning in plan year
2011, non-employer PFFS plans located in network areas and all employer/union
sponsored PFFS plans must meet the access to services requirement by operating
as full network plans.
• The plan must also cover out-of-network Part A and Part B services furnished by
providers who do not have a signed contract or agreement with the plan, if the
provider agrees to accept the plan’s terms and conditions of payment and becomes
a deemed provider as described in 42 CFR 422.216(f) and section 40.2 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
8cbd8ac6ae2308b5b0c196887e94901bb4ef8f91945ad05d8886f82eac9c853f
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