Services Furnished Directly or Through Arrangement

10.2.2 - Services Furnished Directly or Through Arrangement (Rev. 4, 10-01-01) The cost-based HMO/CMP contract with CMS must provide that, in paying for services furnished to the HMO/CMP's enrollees, the HMO/CMP is responsible for: • Determining the eligibility of individuals to receive such items and services through the HMO/CMP; • Making proper coverage decisions and appropriate payment for items and services for which the HMO/CMP's Medicare enrollees are eligible; and • Carrying out any other procedures that CMS may require from time to time. All health care services furnished by the HMO/CMP may be provided through facilities directly (facilities that are owned or related through common control) or under arrangement. An arrangement is defined as a written agreement executed between the HMO/CMP and another entity in which the other entity agrees to furnish specified services to the HMO/CMP's Medicare enrollees; however, the HMO/CMP retains responsibility for those services.