Payments to Providers Participating Under §1886 of the Act

100 - Payments to Providers Participating Under §1886 of the Act (Rev. 4, 10-01-01) An exception is available to a cost-based HMO/CMP with respect to the payment rates set by a State under an approved State reimbursement cost control system. Generally, under such a system, all third party payers must adhere to the inpatient hospital rates set by the State. Section 1886(c)(1)(D) of the Act allows an HMO/CMP to negotiate directly with such hospitals for the rate of payment for purchased inpatient hospital services.