42 CFR 417.458
§ 417.458 Recoupment of uncollected deductible and coinsurance amounts.
United States · 42 CFR — Public Health · Status: effective
Cite this
- Citation
- 42 CFR 417.458, § 417.458 Recoupment of uncollected deductible and coinsurance amounts, United States, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/204226
- Permanent ID
ys:prov:204226@1- SHA-256
27fac636a93ca5b8a6baa0b2d44348ae0643106221021cf54281885dfa8aec22
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Full text
An HMO or CMP agrees not to recoup deductible and coinsurance amounts for which Medicare enrollees were liable in a previous contract period except in the following circumstances:
(a) The HMO or CMP failed to collect the deductible and coinsurance amounts during the contract period in which they were due because of—
(1) Underestimation of the actuarial value of the deductible and coinsurance amounts; or
(2) A billing error.
(b) The HMO or CMP has identified the amounts and obtained advance CMS approval of the recoupment and the method and timing of recoupment.
(c) The HMO or CMP collects these amounts no later than the end of the contract period following the contract period during which they were found to be due.
Legislative history
This is a federal regulation, adopted through agency rulemaking under the Administrative Procedure Act — not enacted by a recorded vote of Congress.