[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR422.206]



[Page 1014]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 422_MEDICARE ADVANTAGE PROGRAM--Table of Contents

 

                 Subpart E_Relationships With Providers

 

Sec. 422.206  Interference with health care professionals' advice to 

enrollees prohibited.



    (a) General rule. (1) An MA organization may not prohibit or 

otherwise restrict a health care professional, acting within the lawful 

scope of practice, from advising, or advocating on behalf of, an 

individual who is a patient and enrolled under an MA plan about--

    (i) The patient's health status, medical care, or treatment options 

(including any alternative treatments that may be self-administered), 

including the provision of sufficient information to the individual to 

provide an opportunity to decide among all relevant treatment options;

    (ii) The risks, benefits, and consequences of treatment or non-

treatment; or

    (iii) The opportunity for the individual to refuse treatment and to 

express preferences about future treatment decisions.

    (2) Health care professionals must provide information regarding 

treatment options in a culturally-competent manner, including the option 

of no treatment. Health care professionals must ensure that individuals 

with disabilities have effective communications with participants 

throughout the health system in making decisions regarding treatment 

options.

    (b) Conscience protection. The general rule in paragraph (a) of this 

section does not require the MA plan to cover, furnish, or pay for a 

particular counseling or referral service if the MA organization that 

offers the plan--

    (1) Objects to the provision of that service on moral or religious 

grounds; and

    (2) Through appropriate written means, makes available information 

on these policies as follows:

    (i) To CMS, with its application for a Medicare contract, within 10 

days of submitting its bid proposal or, for policy changes, in 

accordance with Sec. 422.80 (concerning approval of marketing materials 

and election forms) and with Sec. 422.111.

    (ii) To prospective enrollees, before or during enrollment.

    (iii) With respect to current enrollees, the organization is 

eligible for the exception provided in paragraph (b)(1) of this section 

if it provides notice of such change within 90 days after adopting the 

policy at issue; however, under Sec. 422.111(d), notice of such a 

change must be given in advance.

    (c) Construction. Nothing in paragraph (b) of this section may be 

construed to affect disclosure requirements under State law or under the 

Employee Retirement Income Security Act of 1974.

    (d) Sanctions. An MA organization that violates the prohibition of 

paragraph (a) of this section or the conditions in paragraph (b) of this 

section is subject to intermediate sanctions under subpart O of this 

part.



[63 FR 35085, June 26, 1998, as amended at 65 FR 40325, June 29, 2000; 

70 FR 52026, Sept. 1, 2005]