Medicare Managed Care Manual (Pub. 100-16), Ch. 4 § 110.5.2
Essential Hospitals
110.5.2 – Essential Hospitals
(Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16)
42 CFR §422.112(c) describes the requirements for an RPPO to apply to CMS to
designate a non-contracting hospital as an essential hospital. If CMS approves the
application and the hospital continues to meet the requirements at §422.112(c) then the
essential hospital is “deemed” to be a network hospital of the RPPO and normal in-
network inpatient hospital cost-sharing levels (including the catastrophic limit described
in 42 CFR §422.101(d)(2)) apply to all enrollees accessing covered inpatient hospital
services in that hospital.