[Code of Federal Regulations]
[Title 42, Volume 2]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR422.6]

[Page 833]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 422--MEDICARE+CHOICE PROGRAM--Table of Contents
 
                      Subpart A--General Provisions
 
Sec. 422.6  Application requirements.

    (a) Scope. This section sets forth application requirements for 
entities that seek a contract as an M+C organization offering an M+C 
plan.
    (b) Completion of an application. (1) In order to obtain a 
determination on whether it meets the requirements to become an M+C 
organization and is qualified to provide a particular type of M+C plan, 
an entity, or an individual authorized to act for the entity (the 
applicant) must complete a certified application, in the form and manner 
required by CMS, including the following:
    (i) Documentation of appropriate State licensure or State 
certification that the entity is able to offer health insurance or 
health benefits coverage that meets State-specified standards applicable 
to M+C plans, and is authorized by the State to accept prepaid 
capitation for providing, arranging, or paying for the comprehensive 
health care services to be offered under the M+C contract; or
    (ii) Federal waiver as described in subpart H of this part.
    (2) The authorized individual must describe thoroughly how the 
entity and M+C plan meet, or will meet, the requirements described in 
this part.
    (c) Responsibility for making determinations. CMS is responsible for 
determining whether an entity qualifies as an M+C organization and 
whether proposed M+C plans meet the requirements of this part.
    (d) Resubmittal of application. An application that has been denied 
by CMS may not be resubmitted for 4 months after the date of the notice 
from CMS denying the application.
    (e) Disclosure of application information under the Freedom of 
Information Act. An applicant submitting material that he or she 
believes is protected from disclosure under 5 U.S.C. 552, the Freedom of 
Information Act, or because of exceptions provided in 45 CFR part 5 (the 
Department's regulations providing exceptions to disclosure), should 
label the material ``privileged'' and include an explanation of the 
applicability of an exception described in 45 CFR part 5.