[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: 42CFR405.430]



[Page 104]

 

                         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. 405.430  Failure to properly opt-out.



    (a) A physician or practitioner fails to properly opt-out if--

    (1) Any private contract between the physician or practitioner and a 

Medicare beneficiary, that was entered into before the affidavit 

described in Sec. 405.420 was filed, does not meet the specifications 

of Sec. 405.415; or

    (2) He or she fails to submit the affidavit(s) in accordance with 

Sec. 405.420.

    (b) If a physician or practitioner fails to properly opt-out in 

accordance with paragraph (a) of this section, the following results 

obtain:

    (1) The physician's or practitioner's attempt to opt-out of Medicare 

is nullified, and all of the private contracts between the physician or 

practitioner and Medicare beneficiaries for the two-year period covered 

by the attempted opt-out are deemed null and void.

    (2) The physician or practitioner must submit claims to Medicare for 

all Medicare-covered items and services furnished to Medicare 

beneficiaries, including the items and services furnished under the 

nullified contracts. A nonparticipating physician is subject to the 

limiting charge provisions of Sec. 414.48 of this chapter. A 

participating physician is subject to the limitations on charges of the 

participation agreement he or she signed.

    (3) The practitioner may not reassign any claim except as provided 

in Sec. 424.80 of this chapter.

    (4) The practitioner may neither bill nor collect an amount from the 

beneficiary except for applicable deductible and coinsurance amounts.

    (5) The physician or practitioner may make another attempt to 

properly opt-out at any time.