[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: 42CFR405.405]



[Page 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. 405.405  General rules.



    (a) A physician or practitioner may enter into one or more private 

contracts with Medicare beneficiaries for the purpose of furnishing 

items or services that would otherwise be covered by Medicare, provided 

the conditions of this subpart are met.

    (b) A physician or practitioner who enters into at least one private 

contract with a Medicare beneficiary under the conditions of this 

subpart, and who submits one or more affidavits in accordance with this 

subpart, opts-out of Medicare for a 2-year period unless the opt-out is 

terminated early according to Sec. 405.445. The physician's or 

practitioner's opt-out may be renewed for subsequent 2-year periods.

    (c) Both the private contracts described in paragraph (a) of this 

section and the physician's or practitioner's opt-out described in 

paragraph (b) of this section are null and void if the physician or 

practitioner fails to properly opt-out in accordance with the conditions 

of this subpart.

    (d) Both the private contracts described in paragraph (a) of this 

section and the physician's or practitioner's opt-out described in 

paragraph (b) of this section are null and void for the remainder of the 

opt-out period if the physician or practitioner fails to remain in 

compliance with the conditions of this subpart during the opt-out 

period.

    (e) Services furnished under private contracts meeting the 

requirements of this subpart are not covered services under Medicare, 

and no Medicare payment will be made for such services either directly 

or indirectly, except as permitted in accordance with Sec. 405.435(c).