42 CFR §417.486
Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
The contract must provide that the HMO or CMP agrees to the following:
- (a)To submit to CMS—
- (1)All financial information required under subpart O of this part and for final settlement;
- (2)Any other information necessary for the administration or evaluation of the Medicare program; and
- (3)Risk adjustment data as specified in § 422.310 of this chapter for the purposes of determining an individual's health status. In applying this paragraph (a)(3), references to Medicare Advantage (MA) organizations in § 422.310 must be read to mean HMOs and CMPs.
- (b)To comply with the requirements set forth in part 420, subpart C, of this chapter pertaining to the disclosure of ownership and control information.
- (c)To comply with the requirements of the Privacy Act, as implemented by 45 CFR part 5b and subpart B of part 401 of this chapter, with respect to any system of records developed in performing carrier or intermediary functions under §§ 417.532 and 417.533.
- (d)To meet the confidentiality requirements of § 482.24(b)(3) of this chapter for medical records and for all other enrollee information that is—