42 C.F.R. § 422.114 Access to services under an MA private fee-for-service plan.
Title 42 - Public Health
(a) Sufficient access. (1) An MA organization that offers an MA private fee-for-service plan must demonstrate to CMS that it has sufficient number and range of providers willing to furnish services under the plan. (2) CMS finds that an MA organization meets the requirement in paragraph (a)(1) of this section if, with respect to a particular category of health care providers, the MA organization has— (i) Payment rates that are not less than the rates that apply under original Medicare for the provider in question; (ii) Contracts or agreements with a sufficient number and range of providers to furnish the services covered under the MA private fee-for-service plan; or (iii) A combination of paragraphs (a)(2)(i) and (a)(2)(ii) of this section. (b) Freedom of choice. MA fee-for-service plans must permit enrollees to obtain services from any entity that is authorized to provide services under Medicare Part A and Part B and agrees to provide services under the terms of the plan. (c) Contracted network. Private fee-for-service plans that meet network adequacy requirements for a category of health care professional or provider by meeting the requirements in paragraph (a)(2)(ii) of this section may provide for a higher beneficiary copayment in the case of health care professionals or providers of that same category who do not have contracts or agreements to provide covered services under the terms of the plan. [63 FR 35077, June 26, 1998, as amended at 70 FR 4723, Jan. 28, 2005]
Title 42: Public Health
PART 422—MEDICARE ADVANTAGE PROGRAM
Subpart C—Benefits and Beneficiary Protections
§ 422.114 Access to services under an MA private fee-for-service plan.
