[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: 42CFR405.455]



[Page 106]

 

                         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. 405.455  Application to Medicare+Choice contracts.



    An organization that has a contract with CMS to provide one or more 

Medicare+Choice (M+C) plans to beneficiaries (part 422 of this chapter):

    (a) Must acquire and maintain information from Medicare carriers on 

physicians and practitioners who have opted-out of Medicare.

    (b) Must make no payment directly or indirectly for Medicare covered 

services furnished to a Medicare beneficiary by a physician or 

practitioner who has opted-out of Medicare.

    (c) May make payment to a physician or practitioner who furnishes 

emergency or urgent care services to a beneficiary who has not 

previously entered into a private contract with the physician or 

practitioner in accordance with Sec. 405.440.