---
kind: "section"
citation: "42 C.F.R. § 417.442"
title: "42"
number: "417.442"
heading: "Risk HMO's and CMP's: Conditions for provision of additional benefits."
url: "https://uscodex.org/cfr/42/417.442"
---

# §417.442. Risk HMO's and CMP's: Conditions for provision of additional benefits.

- (a) **General rule.** Except as provided in [paragraph (b)](#b) of this section, a risk HMO or CMP must, during any contract period, provide to its Medicare enrollees the additional benefits described in [§ 417.440(b)(4)](/cfr/42/417.440.md?p=b-4) if its ACRs (calculated in accordance with [§ 417.594](/cfr/42/417.594.md)) are less than the average per capita rates that CMS pays for the Medicare enrollees during the contract period.
- (b) **Exceptions—**
  - (1) **Reduced payment election.** An HMO or CMP is not obligated to furnish additional services under [paragraph (a)](#a) of this section if it has requested a reduction in its monthly payment from CMS under [§ 417.592(e)](/cfr/42/417.592.md?p=e), and it—
    - (i) Elects to receive reduced payment so that there is no difference between the average of its per capita rates of payment and its ACR; or
    - (ii) Elects to receive partially reduced payment and furnish Medicare enrollees with additional benefits described in [§ 417.440 (b)(4)](/cfr/42/417.440.md?p=b-4) so that the combined value of benefits and reduced payment is equivalent to the difference between the average of its per capita rates of payment and its ACR.
  - (2) **Benefit stabilization fund.** An HMO or CMP may elect to have a part of the value of the additional benefits it must provide under [paragraph (a)](#a) of this section withheld in a benefit stabilization fund as described in [§ 417.596](/cfr/42/417.596.md).

## Notes

### Amendments

[50 FR 1346, Jan. 10, 1985; 50 FR 20570, May 17, 1985; 58 FR 38082, July 15, 1993; 60 FR 45678, Sept. 1, 1995]

### Source

Source: 50 FR 1346, Jan. 10, 1985, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302 and 1395hh, and 300e, 300e-5, and 300e-9, and 31 U.S.C. 9701.

### Amendments

[50 FR 1346, Jan. 10, 1985; 50 FR 20570, May 17, 1985; 58 FR 38082, July 15, 1993; 60 FR 45678, Sept. 1, 1995]