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Code of Federal Regulations (Last Updated: July 5, 2024) |
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Title 42 - Public Health |
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Chapter IV - Centers for Medicare & Medicaid Services, Department of Health and Human Services |
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SubChapter B - Medicare Program |
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Part 422 - Medicare Advantage Program |
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Subpart G - Payments to Medicare Advantage Organizations |
§ 422.300 - Basis and scope.
Latest version.
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§ 422.300 Basis and scope.
This subpart is based on sections 1106, 1128J(d), 1852, 1853, 1854, and 1858 of the Act. It sets forth the rules requirements for making payments to Medicare Advantage ( MA ) organizations offering local and regional MA planspolicies, including calculation of MA capitation rates and benchmarks, conditions under which payment is based on plan bids, adjustments to capitation rates (including risk adjustment), collection of risk adjustment data, conditions for use and disclosure of risk adjustment data, collection of improper payments and other payment rules. See § Section 422.458 in subpart J for rules on specifies the requirements for risk sharing payments to MA regional organizations.