[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: 42CFR411.4]



[Page 379]

 

                         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 A_General Exclusions and Exclusion of Particular Services

 

Sec. 411.4  Services for which neither the beneficiary nor any other 

person is legally obligated to pay.



    (a) General rule. Except as provided in Sec. 411.8(b) (for services 

paid by a governmental entity), Medicare does not pay for a service if--

    (1) The beneficiary has no legal obligation to pay for the service; 

and

    (2) No other person or organization (such as a prepayment plan of 

which the beneficiary is a member) has a legal obligation to provide or 

pay for that service.

    (b) Special conditions for services furnished to individuals in 

custody of penal authorities. Payment may be made for services furnished 

to individuals or groups of individuals who are in the custody of the 

police or other penal authorities or in the custody of a government 

agency under a penal statute only if the following conditions are met:

    (1) State or local law requires those individuals or groups of 

individuals to repay the cost of medical services they receive while in 

custody.

    (2) The State or local government entity enforces the requirement to 

pay by billing all such individuals, whether or not covered by Medicare 

or any other health insurance, and by pursuing collection of the amounts 

they owe in the same way and with the same vigor that it pursues the 

collection of other debts.