---
kind: "section"
citation: "42 C.F.R. § 417.592"
title: "42"
number: "417.592"
heading: "Additional benefits requirement."
url: "https://uscodex.org/cfr/42/417.592"
---

# §417.592. Additional benefits requirement.

- (a) **General rules.**
  - (1) An HMO or CMP that has an APCRP (as determined under [§ 417.590](/cfr/42/417.590.md)) greater than its ACR (as determined under [§ 417.594](/cfr/42/417.594.md)) must elect one of the options specified in [paragraph (b)](#b) of this section.
  - (2) The dollar value of the elected option must, over the course of a contract period, be at least equal to the difference between the APCRP and the proposed ACR.
- (b) **Options—**
  - (1) **Additional benefits.** Provide its Medicare enrollees with additional benefits in accordance with [paragraph (c)](#c) of this section.
  - (2) **Payment reduction.** Request CMS to reduce its monthly payments.
  - (3) **Combination of additional benefits and payment reduction.** Provide fewer than the additional benefits required under [paragraph (b)(1)](#b-1) of this section and request CMS to reduce the monthly payments by the remaining difference between the APCRP and the ACR.
  - (4) **Combination of additional benefits and withholding in a stabilization fund.** Provide fewer than the additional benefits required under [paragraph (b)(1)](#b-1) of this section, and request CMS to withhold in a stabilization fund (as provided in [§ 417.596](/cfr/42/417.596.md)) the remaining difference between the APCRP and the ACR.
- (c) **Special rules: Additional benefits option.**
  - (1) The HMO or CMP must determine additional benefits separately for enrollees entitled to both Part A and Part B benefits and those entitled only to Part B.
  - (2) The HMO or CMP may elect to provide additional benefits in any of the following forms—
    - (i) A reduction in the HMO's or CMP's premium or in other charges it imposes in the form of deductibles or coinsurance.
    - (ii) **Health benefits in addition to the required Part A and Part B covered services.**
    - (iii) **A combination of reduced charges and additional benefits.**
- (d) **Notification to CMS.**
  - (1) The HMO or CMP must give CMS notice of its ACR and its weighted APCRP at least 45 days before its contract period begins.
  - (2) An HMO or CMP that elects the option of providing additional benefits must include in its submittal—
    - (i) A description of the additional benefits it will provide to its Medicare enrollees; and
    - (ii) Supporting evidence to show that the selected benefits meet the requirements of [paragraph (a)(2)](#a-2) of this section with respect to dollar value equivalence.

## Notes

### Amendments

[60 FR 46232, Sept. 6, 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

[60 FR 46232, Sept. 6, 1995]