[Code of Federal Regulations]
[Title 42, Volume 2]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR422.214]

[Page 871-872]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 422--MEDICARE+CHOICE PROGRAM--Table of Contents
 
                 Subpart E--Relationships With Providers
 
Sec. 422.214  Special rules for services furnished by noncontract providers.

    (a) Services furnished by non-section 1861(u) providers. (1) Any 
provider (other than a provider of services as defined in section 
1861(u) of the Act) that does not have in effect a contract establishing 
payment amounts for services furnished to a beneficiary enrolled in an 
M+C coordinated care plan or M+C private fee-for-service plan must 
accept, as payment in full, the amounts that the provider could collect 
if the beneficiary were enrolled in original Medicare.
    (2) Any statutory provisions (including penalty provisions) that 
apply to payment for services furnished to a beneficiary not enrolled in 
an M+C plan also apply to the payment described in paragraph (a)(1) of 
this section.

[[Page 872]]

    (b) Services furnished by section 1861(u) providers of service. Any 
provider of services as defined in section 1861(u) of the Act that does 
not have in effect a contract establishing payment amounts for services 
furnished to a beneficiary enrolled in an M+C coordinated care plan or 
M+C private fee-for-service plan must accept as payment in full the 
amounts (less any payments under Secs. 412.105(g) and 413.86(d)) of this 
chapter that it could collect if the beneficiary were enrolled in 
original Medicare. (Section 412.105(g) concerns indirect medical 
education payment to hospitals for managed care enrollees. Section 
413.86(d) concerns calculating payment for direct graduate medical 
education costs.)

[63 FR 35085, June 26, 1998, as amended at 65 FR 40325, June 29, 2000]