US · guidance
CMS SOM App. A, Tag A-0075
§482.12(d)(5) (Continued)
A capital expenditure is not subject to section 1122 review if 75 percent of the health care
facility’s patients who are expected to use the service for which the capital expenditure is made
are individuals enrolled in a health maintenance organization (HMO) or competitive medical
plan (CMP) that meets the requirements of section 1876(b) of the Act, and if the Department
determines that the capital expenditure is for services and facilities that are needed by the
HMO or CMP in order to operate efficiently and economically and that are not otherwise
readily accessible to the HMO or CMP because--
(i) The facilities do not provide common services at the same site;
(ii) The facilities are not available under a contract of reasonable duration;
(iii) Full and equal medical staff privileges in the facilities are not available;
(iv) Arrangements with these facilities are not administratively feasible; or
(v) The purchase of these services is more costly than if the HMO or CMP provided the
services directly.
History
Rev. 37, Issued: 10-17-08; Effective/Implementation Date: 10-17-08
Provenance
- Source
- cms.gov
- Retrieved
- 2026-07-22
- Edition
- som-2026-07-22
- Content hash
e3ef001056d0b0b56d7470b9a2e2883d681e7cbf56bb37aab16efe17a7255ac0
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