[Code of Federal Regulations]
[Title 42, Volume 3]
[Revised as of October 1, 2004]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR489.23]

[Page 940-941]
 
                         TITLE 42--PUBLIC HEALTH
 
  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 
                  HEALTH AND HUMAN SERVICES (CONTINUED)
 
PART 489_PROVIDER AGREEMENTS AND SUPPLIER APPROVAL--Table of Contents
 
               Subpart B_Essentials of Provider Agreements
 
Sec. 489.23  Specific limitation on charges for services provided to 
certain enrollees of fee-for-service FEHB plans.

    A provider that furnishes inpatient hospital services to a retired 
Federal worker age 65 or older who is enrolled in a fee-for-service FEHB 
plan and who is not covered under Medicare Part A, must accept, as 
payment in full, an amount that approximates as closely as possible the 
Medicare inpatient hospital prospective payment system (PPS) rate 
established under part 412. The payment to the provider is composed of a 
payment from the FEHB plan and a payment from the enrollee. This 
combined payment approximates

[[Page 941]]

the Medicare PPS rate. The payment from the FEHB plan approximates, as 
closely as possible, the Medicare PPS rate minus any applicable enrollee 
deductible, coinsurance, or copayment amount. The payment from the 
enrollee is equal to the applicable deductible, coinsurance, or 
copayment amount.

[62 FR 56111, Oct. 29, 1997]