[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: 42CFR411.114]



[Page 401]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 411_EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT

--Table of Contents

 

Subpart E_Limitations on Payment for Services Covered Under Group Health 

                        Plans: General Provisions

 

Sec. 411.114  Determination of nonconformance.



    (a) Starting dates for determination of nonconformance. CMS's 

authority to determine nonconformance of GHPs begins on the following 

dates:

    (1) On January 1, 1987 for MSP provisions that affect the disabled.

    (2) On December 20, 1989 for MSP provisions that affect ESRD 

beneficiaries and the working aged.

    (3) On August 10, 1993 for failure to refund mistaken Medicare 

primary payments.

    (b) Special rule for failure to repay. A GHP that fails to comply 

with Sec. 411.110 (a)(1), (a)(2), or (a)(3) in a particular year is 

nonconforming for that year. If, in a subsequent year, that plan fails 

to repay the resulting mistaken primary payments (in accordance with 

Sec. 411.110(a)(4)), the plan is also nonconforming for the subsequent 

year. For example, if a plan paid secondary for the working aged in 

1991, that plan was nonconforming for 1991. If in 1994 CMS identifies 

mistaken primary payments attributable to the 1991 violation, and the 

plan refuses to repay, it is also nonconforming for 1994.