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42 U.S.C. 1302, 1306, 1395w-21 through 1395w-28, and 1395hh.
63 FR 18134, Apr. 14, 1998, unless otherwise noted.
78 FR 31307, May 23, 2013, unless otherwise noted.
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Subscribe to: 42 CFR 422.2490
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Nomenclature changes to part 422 appear at 70 FR 4741, Jan. 28, 2005.
(a) Terminology. Subject to the exclusions in paragraph (b) of this section, Part C MLR data consists of the information submitted under § 422.2460.
(b) Exclusions from Part C MLR data. For the purpose of this section, the following items are excluded from Part C MLR data:
(1) Narrative descriptions that MA organizations submit to support the information reported to CMS pursuant to the reporting requirements at § 422.2460, such as descriptions of expense allocation methods.
(2)
(i) Information that is reported at the plan level, such as the number of member months associated with each plan under a contract, including information submitted for a contract consisting of only one plan.
(ii) Amounts that are reported as expenditures for a specific type of supplemental benefit, where the entire amount that is reported represents costs incurred by the only plan under the contract that offers that benefit.
(3) Any information that could be used to identify Medicare beneficiaries or other individuals.
(4) MLR review correspondence.
(5) Any information for a contract for those contract years for which the contract is determined to be non-credible, as defined in accordance with § 422.2440(d).
(c) Data release. CMS releases to the public Part C MLR data, for each contract for each contract year, no earlier than 18 months after the end of the applicable contract year.
[81 FR 80557, Nov. 15, 2016, as amended at 83 FR 16736, Apr. 16, 2018; 87 FR 27899, May 9, 2022]