US · guidance
CMS Pub. 100-16, ch. mc86c17a, § 10.2.2
Services Furnished Directly or Through Arrangement
The cost-based HMO/CMP contract with CMS must provide that, in paying for services
furnished to the HMO/CMP's enrollees, the HMO/CMP is responsible for:
• Determining the eligibility of individuals to receive such items and services
through the HMO/CMP;
• Making proper coverage decisions and appropriate payment for items and services
for which the HMO/CMP's Medicare enrollees are eligible; and
• Carrying out any other procedures that CMS may require from time to time.
All health care services furnished by the HMO/CMP may be provided through facilities
directly (facilities that are owned or related through common control) or under
arrangement. An arrangement is defined as a written agreement executed between the
HMO/CMP and another entity in which the other entity agrees to furnish specified
services to the HMO/CMP's Medicare enrollees; however, the HMO/CMP retains
responsibility for those services.
History
(Rev. 4, 10-01-01)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
e2117671f2f26cb2b974d314a540e4615ecafcca801d7fdd36e397e9b5997833
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