42 CFR 422.102 - Supplemental benefits.
(a)Mandatory supplemental benefits.
(1) Subject to CMS approval, an MA organization may require Medicare enrollees of an MA plan (other than an MSA plan) to accept or pay for services in addition to Medicare-covered services described in § 422.101.
(b)Optional supplemental benefits. Except as provided in § 422.104 in the case of MSA plans, each MA organization may offer (for election by the enrollee and without regard to health status) services that are not included in the basic benefits as described in § 422.100(c) and any mandatory supplemental benefits described in paragraph (a) of this section. Optional supplemental benefits are purchased at the discretion of the enrollee and must be offered to all Medicare beneficiaries enrolled in the MA plan.
(d)Marketing of supplemental benefits. MA organizations may offer enrollees a group of services as one optional supplemental benefit, offer services individually, or offer a combination of groups and individual services.
(e)Supplemental benefits for certain dual eligible special needs plans. Subject to CMS approval, dual eligible special needs plans that meet a high standard of integration and minimum performance and quality-based standards may offer additional supplemental benefits, consistent with the requirements of this part, where CMS finds that the offering of such benefits could better integrate care for the dual eligible population provided that the special needs plan -
(1) Operated in the MA contract year prior to the MA contract year for which it is submitting its bid; and
- 42 CFR 422.566 — Organization Determinations.
- 42 CFR 422.254 — Submission of Bids.
- 42 CFR 422.105 — Special Rules for Self-Referral and Point of Service Option.
- 42 CFR 422.252 — Terminology.
- 42 CFR 422.504 — Contract Provisions.
- 42 CFR 422.109 — Effect of National Coverage Determinations (NCDs) and Legislative Changes in Benefits.
- 42 CFR 422.111 — Disclosure Requirements.
- 42 CFR 422.266 — Beneficiary Rebates.