[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: 42CFR409.100]



[Page 315]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 409_HOSPITAL INSURANCE BENEFITS--Table of Contents

 

            Subpart H_Payment of Hospital Insurance Benefits

 

Sec. 409.100  To whom payment is made.



    Source: 53 FR 6633, Mar. 2, 1988, unless otherwise noted.





    (a) Basic rule. Except as provided in paragraph (b) of this 

section--

    (1) Medicare pays hospital insurance benefits only to a 

participating provider.

    (2) For home health services (including medical supplies described 

in section 1861(m)(5) of the Act, but excluding durable medical 

equipment to the extent provided for in such section) furnished to an 

individual who at the time the item or service is furnished is under a 

plan of care of an HHA, payment is made to the HHA (without regard to 

whether the item or service is furnished by the HHA directly, under 

arrangement with the HHA, or under any other contracting or consulting 

arrangement).

    (b) Exceptions. Medicare may pay hospital insurance benefits as 

follows:

    (1) For emergency services furnished by a nonparticipating hospital, 

to the hospital or to the beneficiary, under the conditions prescribed 

in subpart G of part 424 of this chapter.

    (2) For services furnished by a Canadian or Mexican hospital, to the 

hospital or to the beneficiary, under the conditions prescribed in 

subpart H of part 424 of this chapter.



[53 FR 6633, Mar. 2, 1988, as amended at 65 FR 41211, July 3, 2000]