US · guidance
CMS Pub. 100-16, ch. mc86c17a, § 80.2
Certain Provider Costs
A HMO/CMP has the option to have hospitals and SNFs, that furnish covered services to
the HMO/CMP's Medicare enrollees, obtain payment directly from Medicare on the
HMO/CMP's behalf (See Chapter 17, Subchapter B). When the HMO/CMP opts for this
alternative, these providers are each paid the cost for the Medicare covered services
furnished to the Medicare enrollee. This determination is made using Medicare's payment
principles or Medicare's prospective payments, as appropriate, and the amounts paid are
deducted from the payments to the HMO/CMP.
History
(Rev. 4, 10-01-01)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
c4bfe3a38bccc4abbdc468ca94791338cfcab93b1214df251e311f0e33484124
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.