[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: 42CFR415.204]



[Page 808]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 415_SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING 

PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS

--Table of Contents

 

                     Subpart E_Services of Residents

 

Sec. 415.204  Services of residents in skilled nursing facilities and 

home health agencies.



    (a) Medicare Part A payment. Payment is made under Medicare Part A 

for interns' and residents' services furnished in the following settings 

that meet the specified requirements:

    (1) Skilled nursing facility. Payment to a participating skilled 

nursing facility may include the cost of services of an intern or 

resident who is in an approved GME program in a hospital with which the 

skilled nursing facility has a transfer agreement that provides, in 

part, for the transfer of patients and the interchange of medical 

records.

    (2) Home health agency. A participating home health agency may 

receive payment for the cost of the services of an intern or resident 

who is under an approved GME program of a hospital with which the home 

health agency is affiliated or under common control if these services 

are furnished as part of the home health visits for a Medicare 

beneficiary. (Nevertheless, see Sec. Sec. 413.75 through 413.83 of this 

chapter for the costs of approved GME programs in hospital-based 

providers.)

    (b) Medicare Part B payment. Medical services of a resident of a 

hospital that are furnished by a skilled nursing facility or home health 

agency are paid under Medicare Part B if payment is not provided under 

Medicare Part A. Payment is made under Part B for a resident's services 

by reducing the reasonable costs of furnishing the services by the 

beneficiary deductible and paying 80 percent of the remaining amount.



[60 FR 63178, Dec. 8, 1995, as amended at 70 FR 47490, Aug. 12, 2005]