[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: 42CFR416.30]



[Page 811-812]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 416_AMBULATORY SURGICAL SERVICES--Table of Contents

 

              Subpart B_General Conditions and Requirements

 

Sec. 416.30  Terms of agreement with CMS.



    As part of the agreement under Sec. 416.26 the ASC must agree to 

the following:

    (a) Compliance with coverage conditions. The ASC agrees to meet the 

conditions for coverage specified in subpart C of this part and to 

report promptly to CMS any failure to do so.

    (b) Limitation on charges to beneficiaries. \1\ The ASC agrees to 

charge the beneficiary or any other person only the applicable 

deductible and coinsurance amounts for facility services for which the 

beneficiary--

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    \1\ For facility services furnished before July 1987, the ASC had to 

agree to make no charge to the beneficiary, since those services were 

not subject to the part B deductible and coinsurance provisions.

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    (1) Is entitled to have payment made on his or her behalf under this 

part; or

    (2) Would have been so entitled if the ASC had filed a request for 

payment in accordance with Sec. 410.165 of this chapter.

    (c) Refunds to beneficiaries. (1) The ASC agrees to refund as 

promptly as possible any money incorrectly collected from beneficiaries 

or from someone on their behalf.

    (2) As used in this section, money incorrectly collected means sums 

collected in excess of those specified in paragraph (b) of this section. 

It includes amounts collected for a period of time when the beneficiary 

was believed not to be entitled to Medicare benefits if--

    (i) The beneficiary is later determined to have been entitled to 

Medicare benefits; and

    (ii) The beneficiary's entitlement period falls within the time the 

ASC's agreement with CMS is in effect.



[[Page 812]]



    (d) Furnishing information. The ASC agrees to furnish to CMS, if 

requested, information necessary to establish payment rates specified in 

Sec. Sec. 416.120-416.130 in the form and manner that CMS requires.

    (e) Acceptance of assignment. The ASC agrees to accept assignment 

for all facility services furnished in connection with covered surgical 

procedures. For purposes of this section, assignment means an assignment 

under Sec. 424.55 of this chapter of the right to receive payment under 

Medicare Part B and payment under Sec. 424.64 of this chapter (when an 

individual dies before assigning the claim).

    (f) ASCs operated by a hopsital. In an ASC operated by a hospital--

    (1) The agreement is made effective on the first day of the next 

Medicare cost reporting period of the hospital that operates the ASC; 

and

    (2) The ASC participates and is paid only as an ASC, without the 

option of converting to or being paid as a hospital outpatient 

department, unless CMS determines there is good cause to do otherwise.

    (3) Costs for the ASC are treated as a non-reimbursable cost center 

on the hopsital's cost report.

    (g) Additional provisions. The agreement may contain any additional 

provisions that CMS finds necessary or desirable for the efficient and 

effective administration of the Medicare program.



[47 FR 34094, Aug. 5, 1982, as amended at 51 FR 41351, Nov. 14, 1986; 56 

FR 8844, Mar. 1, 1991]