yourstate.us
42 CFR 417.544

§ 417.544 Physicians' services furnished directly by the HMO or CMP.

United States · 42 CFR — Public Health · Status: effective

Get this as JSONEmbed this
Cite this
Citation
42 CFR 417.544, § 417.544 Physicians' services furnished directly by the HMO or CMP, United States, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/204264
Permanent ID
ys:prov:204264@1
SHA-256
d5f1ebe0dd18a8cb4eb70d7c1db42b5455714792c9626d1d50821910470022eb

The hash is SHA-256 of this version's text, with every run of whitespace collapsed to a single space and the ends trimmed. The ID always leads back here, and checking it says whether the text you cited is still the current version.

Full text

(a) Principles. (1) Compensation paid by an HMO or CMP to physicians is an allowable cost to the extent that it is commensurate with the compensation paid for similar services performed by similar physicians practicing in the same or a similar locality. (2) Physician compensation may take various forms, but the aggregate compensation allowable must be reasonable in relation to the services personally furnished. (3) If aggregate physician compensation costs exceed what is normally incurred, the excess is not a reasonable cost. (b) Application. (1) In determining the allowability of the costs of physicians' services, the cost of personal services (for example, expenses attributable to salaries, wages, incentive payments, fringe benefits) must be distinguished from the cost of nonpersonal services (for example, expenses attributable to facilities, equipment, support personnel, supplies). (2) To be allowable, compensation must be reasonable in relation to the personal services furnished.

Legislative history

This is a federal regulation, adopted through agency rulemaking under the Administrative Procedure Act — not enacted by a recorded vote of Congress.