[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: 42CFR422.220]



[Page 1019]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 422_MEDICARE ADVANTAGE PROGRAM--Table of Contents

 

                 Subpart E_Relationships With Providers

 

Sec. 422.220  Exclusion of services furnished under a private contract.



    An MA organization may not pay, directly or indirectly, on any 

basis, for services (other than emergency or urgently needed services as 

defined in Sec. 422.2) furnished to a Medicare enrollee by a physician 

(as defined in section 1861(r)(1) of the Act) or other practitioner (as 

defined in section 1842(b)(18)(C) of the Act) who has filed with the 

Medicare carrier an affidavit promising to furnish Medicare-covered 

services to Medicare beneficiaries only through private contracts under 

section 1802(b) of the Act with the beneficiaries. An MA organization 

must pay for emergency or urgently needed services furnished by a 

physician or practitioner who has not signed a private contract with the 

beneficiary.