Special Rules for RPPOs

110.5 – Special Rules for RPPOs (Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16) 110.5.1 -- Access through Non-contracted Providers (Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16) Situations may arise where an MA plan cannot establish contracts with providers that meet Medicare access requirements in portions of an RPPO’s defined service area. In such cases, RPPOs may meet Medicare access requirements by demonstrating to CMS’ satisfaction that there is adequate access to all plan-covered services through arrangements other than through contracted provider (42 CFR §422.112(a)(1)(ii)). Enrollees who receive plan-covered services in non-network areas of an RPPO must be covered at in-network cost-sharing levels for the enrollee.