(a) Responsibility for making determinations. CMS is responsible for determining whether an entity meets the requirements to be an HMO or CMP.
(b) Application requirements. (1) The application requirements for HMOs are set forth in Sec. 417.143.
(1) The application requirements for HMOs are set forth in Sec. 417.143.
(2) The requirements of Sec. 417.143 also apply to CMPs except that there are no application fees.
(c) Determination. CMS uses the procedures set forth in Sec. 417.144(a) through (d) to determine whether an entity is an HMO or CMP.
(d) Oversight of continuing compliance. (1) CMS oversees an entity's continued compliance with the requirements for an HMO as defined in Sec. 417.1 or for a CMP as set forth in Sec. 417.407.
(1) CMS oversees an entity's continued compliance with the requirements for an HMO as defined in Sec. 417.1 or for a CMP as set forth in Sec. 417.407.
(2) If an entity no longer meets those requirements, CMS terminates the contract of that entity in accordance with Sec. 417.494. [60 FR 45675, Sept. 1, 1995]