---
kind: "section"
citation: "42 C.F.R. § 438.806"
title: "42"
number: "438.806"
heading: "Prior approval."
url: "https://uscodex.org/cfr/42/438.806"
---

# §438.806. Prior approval.

- (a) **Comprehensive risk contracts.** FFP is available under a comprehensive risk contract only if all of the following apply:
  - (1) CMS has confirmed that the contractor meets the definition of an MCO or is one of the entities described in [paragraphs (b)(2) through (5)](/cfr/42/438.3.md?p=b-2..b-5) of § 438.3.
  - (2) The contract meets all the requirements of section 1903(m)(2)(A) of the Act, the applicable requirements of section 1932 of the Act, and the provisions of this part.
- (b) **MCO contracts.** Prior approval by CMS is a condition for FFP under any MCO contract that extends for less than one full year or that has a value equal to, or greater than, the following threshold amounts:
  - (1) **For 1998, the threshold is $1,000,000.**
  - (2) For subsequent years, the amount is increased by the percentage increase in the consumer price index for all urban consumers.
- (c) FFP is not available in an MCO contract that does not have prior approval from CMS under [paragraph (b)](#b) of this section.

## Notes

### Source

Source: 81 FR 27853, May 6, 2016, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302.

### Source

Source: 67 FR 41095, June 14, 2002, unless otherwise noted.