[Code of Federal Regulations]
[Title 12, Volume 1]
[Revised as of January 1, 2003]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR498.2]

[Page 1088-1089]
 
                         TITLE 42--PUBLIC HEALTH
 
  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 
                 HEALTH AND HUMAN SERVICES--(Continued)
 
 PART 498--APPEALS PROCEDURES FOR DETERMINATIONS THAT AFFECT PARTICIPATION IN THE MEDICARE PROGRAM AND FOR DETERMINATIONS THAT AFFECT THE PARTICIPATION OF ICFs/
MR AND CERTAIN NFs IN THE MEDICAID PROGRAM--Table of Contents
 
                      Subpart A--General Provisions
 
Sec. 498.2  Definitions.

    As used in this part--
    Affected party means a provider, prospective provider, supplier, 
prospective supplier, or practitioner that is affected by an initial 
determination or by any subsequent determination or decision issued 
under this part, and ``party'' means the affected party or CMS (or the 
OIG), as appropriate.
    ALJ stands for Administrative Law Judge.
    Departmental Appeals Board or Board means a Board established in the 
Office of the Secretary to provide impartial review of disputed 
decisions made by the operating components of the Department.
    OHA stands for the Social Security Administration's Office of 
Hearings and Appeals.
    OIG stands for the Department's Office of the Inspector General.
    Provider means a hospital, critical access hospital (CAH), skilled 
nursing facility (SNF), comprehensive outpatient rehabilitation facility 
(CORF), home health agency (HHA), or hospice, that has in effect an 
agreement to participate in Medicare, that has in effect an agreement to 
participate in Medicaid, or a clinic, rehabilitation agency, or public 
health agency that has a similar agreement but only to furnish 
outpatient physical therapy or outpatient speech pathology services, and 
prospective provider means any of the listed entities that seeks to 
participate in Medicare as a provider or to have any facility or 
organization determined to be a department of the provider or provider-
based entity under Sec. 413.65 of this chapter.
    Supplier means an independent laboratory, supplier of portable X-ray 
services, rural health clinic (RHC), Federally qualified health center 
(FQHC), ambulatory surgical center (ASC), organ procurement organization 
(OPO), an entity approved by CMS to furnish outpatient diabetes self-
management training, or end-stage renal

[[Page 1089]]

disease (ESRD) treatment facility that is approved by CMS as meeting the 
conditions for coverage of its services, and prospective supplier means 
any of the listed entities that seeks to be approved for coverage of its 
services under Medicare. (However, for purposes of the sanctions and 
penalties that may be imposed by the OIG, the term supplier has the 
meaning specified in Sec. 1001.2 of this title.)

[52 FR 22446, June 12, 1987, as amended at 53 FR 6551, March 1, 1988; 57 
FR 24984, June 12, 1992; 58 FR 30677, May 26, 1993; 59 FR 6579, Feb. 11, 
1994; 59 FR 56251, Nov. 10, 1994; 61 FR 32350, June 24, 1996; 62 FR 
46037, Aug. 29, 1997; 65 FR 18549, Apr. 7, 2000; 65 FR 83154, Dec. 29, 
2000]