[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: 42CFR411.8]



[Page 379-380]

 

                         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. 411.8  Services paid for by a Government entity.



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

Medicare does not pay for services that are paid for directly or 

indirectly by a government entity.

    (b) Exceptions. Payment may be made for the following:

    (1) Services furnished under a health insurance plan established for 

employees of the government entity.

    (2) Services furnished under a title of the Social Security Act 

other than title XVIII.



[[Page 380]]



    (3) Services furnished in or by a participating general or special 

hospital that--

    (i) Is operated by a State or local government agency; and

    (ii) Serves the general community.

    (4) Services furnished in a hospital or elsewhere, as a means of 

controlling infectious diseases or because the individual is medically 

indigent.

    (5) Services furnished by a participating hospital or SNF of the 

Indian Health Service.

    (6) Services furnished by a public or private health facility that--

    (i) Is not a Federal provider or other facility operated by a 

Federal agency;

    (ii) Receives U.S. government funds under a Federal program that 

provides support to facilities that furnish health care services;

    (iii) Customarily seeks payment for services not covered under 

Medicare from all available sources, including private insurance and 

patients' cash resources; and

    (iv) Limits the amounts it collects or seeks to collect from a 

Medicare Part B beneficiary and others on the beneficiary's behalf to:

    (A) Any unmet deductible applied to the charges related to the 

reasonable costs that the facility incurs in providing the covered 

services;

    (B) Twenty percent of the remainder of those charges;

    (C) The charges for noncovered services.

    (7) Rural health clinic services that meet the requirements set 

forth in part 491 of this chapter.



[54 FR 41734, Oct. 11, 1989, as amended at 56 FR 2139, Jan. 22, 1991]