---
kind: "section"
citation: "42 C.F.R. § 417.448"
title: "42"
number: "417.448"
heading: "Restriction on payments for services received by Medicare enrollees of risk HMOs or CMPs."
url: "https://uscodex.org/cfr/42/417.448"
---

# §417.448. Restriction on payments for services received by Medicare enrollees of risk HMOs or CMPs.

- (a) **Basic rule.** Except for emergency and urgently needed services as defined in [§ 417.401](/cfr/42/417.401.md), risk HMOs or CMPs are not required to make payments to or on behalf of certain Medicare enrollees, for any services received by the enrollees that are not provided—
  - (1) Directly by the HMO or CMP; or
  - (2) **Through arrangements made by the HMO or CMP.**
- (b) **Application.** The restriction on payments for services imposed by [paragraph (a)](#a) of this section applies to services received by—
  - (1) New Medicare enrollees;
  - (2) Nonrisk Medicare enrollees who convert to risk reimbursement; and
  - (3) **Nonrisk Medicare enrollees who elect special supplemental benefit plans.**
- (c) **End of restriction.** The restriction of payments imposed by [paragraph (a)](#a) of this section ends when a Medicare enrollee leaves the HMO's or CMP's geographic area for an extended period as defined in [§ 471.460(a)(2)](/cfr/42/471.460.md?p=a-2) and the HMO or CMP and the enrollee make arrangements for enrollment to continue as provided in [§ 417.460(a)(2)(iv)](/cfr/42/417.460.md?p=a-2-iv).
- (d) **Timing.** The effective date for the end of the restriction on payments, as discussed in [paragraph (c)](#c) of this section is the first day of the first month following the month in which the enrollee notifies the HMO or CMP as required in [§ 417.436(a)(9)](/cfr/42/417.436.md?p=a-9), that he or she has left the HMO's or CMP's geographic area for an extended period.

## Notes

### Amendments

[51 FR 28573, Aug. 8, 1986, as amended at 56 FR 46571, Sept. 13, 1991; 58 FR 38079, July 15, 1993]

### 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

[51 FR 28573, Aug. 8, 1986, as amended at 56 FR 46571, Sept. 13, 1991; 58 FR 38079, July 15, 1993]