Payment Rules for Direct-Contracting Providers

70.3.2 - Payment Rules for Direct-Contracting Providers (Rev. 99, Issued: 05-27-11, Effective: 05-27-11, Implementation: 05-27-11) • The plan may establish payment rates for direct-contracting providers that are different than the rates established in the terms and conditions of payment for deemed providers. The plan may also vary the payment rates among the direct- contracting providers within a particular category of Part A or Part B service. • The payment rates for direct-contracting providers may be higher, lower, or equal to the Original Medicare rates. • The payment rates for direct-contracting providers must be established in the signed contract or agreement between the plan and the provider. • The payment rates can be provider-specific, and public disclosure of the rates is not required.