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Code of Federal Regulations (Last Updated: November 8, 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 H - Health Care Infrastructure and Model Programs |
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Part 513 - Most Favored Nation (MFN) Model |
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Subpart C - Payment Process and Methodology |
§ 513.200 - Payment process and beneficiary cost-sharing.
Latest version.
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§ 513.200 Payment process and beneficiary cost-sharing.
(a) General. For purposes of the MFN Model, the allowed MFN Drug Payment Amount does not exceed the billed amount on the claim for the MFN Model drug.
(b) Model-specific billing instructions. MFN participants submit claims for MFN Model drugs to the applicable MAC in the form and manner specified by CMS in model-specific billing instructions.
(c) Beneficiary cost-sharing. Beneficiary coinsurance does not apply to the portion of the allowed payment amount for an MFN Model drug that is determined under § 513.220.