[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: 42CFR422.8]

[Page 833-834]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 422--MEDICARE+CHOICE PROGRAM--Table of Contents
 
                      Subpart A--General Provisions
 
Sec. 422.8  Evaluation and determination procedures.

    (a) Basis for evaluation and determination. (1) CMS evaluates an 
application for an M+C contract on the basis of information contained in 
the application itself and any additional information that CMS obtains 
through on-site visits, public hearings, and any other appropriate 
procedures.
    (2) If the application is incomplete, CMS notifies the contract 
applicant and allows 60 days from the date of the notice for the 
contract applicant to furnish the missing information.
    (3) After evaluating all relevant information, CMS determines 
whether the contract applicant's application meets the applicable 
requirements of Sec. 422.6.
    (b) Use of information from a prior contracting period. If an M+C 
organization, HMO, competitive medical plan, or health care prepayment 
plan has failed to comply with the terms of a previous year's contract 
with CMS under title XVIII of the Act, or has failed to complete a 
corrective action plan during the term of the contract, CMS may deny an 
application from a contract

[[Page 834]]

applicant based on the contract applicant's failure to comply with that 
prior contract with CMS even if the contract applicant meets all of the 
current requirements.
    (c) Notice of determination. CMS notifies each applicant that 
applies for an M+C contract under this part of its determination and the 
basis for the determination. The determination may be approval, intent 
to deny, or denial.
    (d) Approval of application. If CMS approves the application, it 
gives written notice to the contract applicant, indicating that it meets 
the requirements for an M+C contract.
    (e) Intent to deny. (1) If CMS finds that the contract applicant 
does not appear to meet the requirements for an M+C organization and 
appears to be able to meet those requirements within 60 days, CMS gives 
the contract applicant notice of intent to deny the application for an 
M+C contract and a summary of the basis for this preliminary finding.
    (2) Within 60 days from the date of the notice, the contract 
applicant may respond in writing to the issues or other matters that 
were the basis for CMS's preliminary finding and may revise its 
application to remedy any defects CMS identified.
    (f) Denial of application. If CMS denies the application, it gives 
written notice to the contract applicant indicating--
    (1) That the contract applicant does not meet the contract 
requirements under part C of title XVIII of the Act;
    (2) The reasons why the contract applicant does not meet the 
contract requirements; and
    (3) The contract applicant's right to request reconsideration in 
accordance with the procedures specified in subpart N of this part.
    (g) Oversight of continuing compliance. (1) CMS oversees an M+C 
organization's continued compliance with the requirements for an M+C 
organization.
    (2) If an M+C organization no longer meets those requirements, CMS 
terminates the contract in accordance with Sec. 422.510.

[65 FR 40315, June 29, 2000]