42 C.F.R. § 422.322 Source of payment and effect of MA plan election on payment.
Title 42 - Public Health
(a) Source of payments. (1) Payments under this subpart for original fee-for-service benefits to MA organizations or MA MSAs are made from the Federal Hospital Insurance Trust Fund or the Supplementary Medical Insurance Trust Fund. CMS determines the proportions to reflect the relative weight that benefits under Part A, and benefits under Part B represents of the actuarial value of the total benefits under title XVIII of the Act. (2) Payments to MA-PD organizations for statutory drug benefits provided under this title are made from the Medicare Prescription Drug Account in the Federal Supplementary Medical Insurance Trust Fund. (b) Payments to the MA organization. Subject to §412.105(g) and §413.86(d) of this chapter and §422.109, §422.316, and §422.320, CMS' payments under a contract with an MA organization (described in §422.304) with respect to an individual electing an MA plan offered by the organization are instead of the amounts which (in the absence of the contract) would otherwise be payable under original Medicare for items and services furnished to the individual. (c) Only the MA organization entitled to payment. Subject to §422.314, §422.316, §422.318, §422.320, and §422.520 and sections 1886(d)(11) and 1886(h)(3)(D) of the Act, only the MA organization is entitled to receive payment from CMS under title XVIII of the Act for items and services furnished to the individual. [70 FR 4729, Jan. 28, 2005, as amended at 70 FR 52027, Sept. 1, 2005]
Title 42: Public Health
PART 422—MEDICARE ADVANTAGE PROGRAM
Subpart G—Payments to Medicare Advantage Organizations
§ 422.322 Source of payment and effect of MA plan election on payment.
