42 C.F.R. § 417.640 Determinations subject to appeal.
Title 42 - Public Health
This subpart establishes the procedures for making and reviewing the following initial determinations: (a) A determination that an HMO or CMP is not qualified to enter into a contract with CMS under section 1876 of the Act. (b) A determination that an HMO or CMP is qualified only for a reasonable cost contract. (c) A determination to terminate, or to refuse to renew, a contract with an HMO or CMP because— (1) The HMO or CMP has failed substantially to carry out the terms of the contract; (2) The HMO or CMP is carrying out the contract in a manner that is inconsistent with the efficient and effective administration of section 1876 of the Act; (3) The HMO or CMP no longer meets the applicable conditions necessary to qualify as an HMO or CMP under section 1876 of the Act and this subpart; or (4) The HMO or CMP has failed to comply with the composition of enrollment requirements specified in §417.413(d). [50 FR 1346, Jan. 10, 1985, as amended at 56 FR 46572, Sept. 13, 1991; 58 FR 38080, July 15, 1993]
Title 42: Public Health
PART 417—HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS
Subpart R—Medicare Contract Appeals
§ 417.640 Determinations subject to appeal.
