[Code of Federal Regulations]
[Title 42, Volume 3]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR1002.211]

[Page 1146-1147]
 
                         TITLE 42--PUBLIC HEALTH
 
                     CHAPTER V--OFFICE OF INSPECTOR
                          GENERAL--HEALTH CARE,
                        DEPARTMENT OF HEALTH AND
                             HUMAN SERVICES
 
PART 1002--PROGRAM INTEGRITY--STATE-INITIATED EXCLUSIONS FROM MEDICAID--Table of Contents
 
                    Subpart C--Permissive Exclusions
 
Sec. 1002.211  Effect of exclusion.

    (a) Denial of payment. Except as provided for in 
Sec. 1001.1901(c)(3), (c)(4) and (c)(5)(i) of this chapter, no payment 
may be made by the State agency for any item or service furnished on or 
after the effective date specified in the notice by an excluded 
individual or entity, or at the medical direction or on the prescription 
of a physician who is excluded when a person furnishing such item or 
service knew, or had reason to know, of the exclusion.
    (b) Denial of FFP. FFP is not available where the State agency is 
required to deny payment under paragraph (a) of this section. FFP will 
be reinstated at such time as the excluded individual

[[Page 1147]]

or entity is reinstated in the Medicaid program.

[57 FR 3343, Jan. 29, 1992, as amended at 63 FR 46691, Sept. 2, 1998]