[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR405.400]



[Page 100-101]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 405_FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED--Table of 

Contents

 

                       Subpart D_Private Contracts

 

Sec. 405.400  Definitions.



    Authority: Secs. 1102, 1802, and 1871 of the Social Security Act (42 

U.S.C. 1302, 1395a, and 1395hh).



    Source: 63 FR 58901, Nov. 2, 1998, unless otherwise noted.





    For purposes of this subpart, the following definitions apply:

    Beneficiary means an individual who is enrolled in Part B of 

Medicare.

    Emergency care services means services furnished to an individual 

for treatment of an ``emergency medical condition'' as that term is 

defined in Sec. 422.2 of this chapter.

    Legal representative means one or more individuals who, as 

determined by applicable State law, has the legal authority to enter 

into the contract with the physician or practitioner on behalf of the 

beneficiary.

    Opt-out means the status of meeting the conditions specified in 

Sec. 405.410.

    Opt-out period means the 2-year period beginning on the effective 

date of the affidavit as specified by Sec. 405.410(c)(1) or Sec. 

405.410(c)(2), as applicable.

    Participating physician means a ``physician'' as defined in this 

section who has signed an agreement to participate in Part B of 

Medicare.

    Physician means a doctor of medicine; doctor of osteopathy; doctor 

of dental surgery or of dental medicine; doctor of podiatric medicine; 

or doctor of optometry who is legally authorized to practice medicine, 

osteopathy, dental surgery, dental medicine, podiatric medicine, or 

optometry by the State in which he performs such function and who is 

acting within the scope of his license when he performs such functions.

    Practitioner means a physician assistant, nurse practitioner, 

clinical nurse specialist, certified registered nurse anesthetist, 

certified nurse midwife, clinical psychologist, or clinical social 

worker, who is currently legally authorized to practice in that capacity 

by each State in which he or she furnishes services to patients or 

clients.

    Private contract means a document that meets the criteria specified 

in Sec. 405.415.



[[Page 101]]



    Properly opt-out means to complete, without defect, the requirements 

for opt-out as specified in Sec. 405.410.

    Properly terminate opt-out means to complete, without defect, the 

requirements for terminating opt-out as specified in Sec. 405.445.

    Urgent care services means services furnished to an individual who 

requires services to be furnished within 12 hours in order to avoid the 

likely onset of an emergency medical condition.



[63 FR 58901, Nov. 2, 1998, as amended at 69 FR 1116, Jan. 7, 2004]