[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR489.1]



[Page 933-934]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 489_PROVIDER AGREEMENTS AND SUPPLIER APPROVAL--Table of Contents

 

                      Subpart A_General Provisions

 

Sec. 489.1  Statutory basis.









                      Subpart A_General Provisions



Sec.

489.1 Statutory basis.

489.2 Scope of part.

489.3 Definitions.

489.10 Basic requirements.

489.11 Acceptance of a provider as a participant.

489.12 Decision to deny an agreement.

489.13 Effective date of agreement or approval.

489.18 Change of ownership or leasing: Effect on provider agreement.



               Subpart B_Essentials of Provider Agreements



489.20 Basic commitments.

489.21 Specific limitations on charges.

489.22 Special provisions applicable to prepayment requirements.

489.23 Specific limitation on charges for services provided to certain 

          enrollees of fee-for-service FEHB plans.

489.24 Special responsibilities of Medicare hospitals in emergency 

          cases.

489.25 Special requirements concerning CHAMPUS and CHAMPVA programs.

489.26 Special requirements concerning veterans.

489.27 Beneficiary notice of discharge rights.

489.28 Special capitalization requirements for HHAs.



                       Subpart C_Allowable Charges



489.30 Allowable charges: Deductibles and coinsurance.

489.31 Allowable charges: Blood.

489.32 Allowable charges: Noncovered and partially covered services.

489.34 Allowable charges: Hospitals participating in State reimbursement 

          control systems or demonstration projects.



[[Page 934]]



489.35 Notice to intermediary.



               Subpart D_Handling of Incorrect Collections



489.40 Definition of incorrect collection.

489.41 Timing and methods of handling.

489.42 Payment of offset amounts to beneficiary or other person.



 Subpart E_Termination of Agreement and Reinstatement After Termination



489.52 Termination by the provider.

489.53 Termination by CMS.

489.54 Termination by the OIG.

489.55 Exceptions to effective date of termination.

489.57 Reinstatement after termination.



               Subpart F_Surety Bond Requirements for HHAs



489.60 Definitions.

489.61 Basic requirement for surety bonds.

489.62 Requirement waived for Government-operated HHAs.

489.63 Parties to the bond.

489.64 Authorized Surety and exclusion of surety companies.

489.65 Amount of the bond.

489.66 Additional requirements of the surety bond.

489.67 Term and type of bond.

489.68 Effect of failure to obtain, maintain, and timely file a surety 

          bond.

489.69 Evidence of compliance.

489.70 Effect of payment by the Surety.

489.71 Surety's standing to appeal Medicare determinations.

489.72 Effect of review reversing CMS's determination.

489.73 Effect of conditions of payment.

489.74 Incorporation into existing provider agreements.



Subparts G-H [Reserved]



                      Subpart I_Advance Directives



489.100 Definition.

489.102 Requirements for providers.

489.104 Effective dates.



    Authority: Secs. 1102, 1819, 1861, 1864(m), 1866, 1869, and 1871 of 

the Social Security Act (42 U.S.C. 1302, 1395i-3, 1395x, 1395aa(m), 

1395cc, 1395ff, and 1395hh).



    Source: 45 FR 22937, Apr. 4, 1980, unless otherwise noted.







    This part implements section 1866 of the Social Security Act. 

Section 1866 specifies the terms of provider agreements, the grounds for 

terminating a provider agreement, the circumstances under which payment 

for new admissions may be denied, and the circumstances under which 

payment may be withheld for failure to make timely utilization review. 

The following other sections of that Act are also pertinent.

    (a) Section 1861 defines the services covered under Medicare and the 

providers that may be reimbursed for furnishing those services.

    (b) Section 1864 provides for the use of State survey agencies to 

ascertain whether certain entities meet the conditions of participation.

    (c) Section 1871 authorizes the Secretary to prescribe regulations 

for the administration of the Medicare program.

    (d) Although section 1866 of the Act speaks only to providers and 

provider agreements, the effective date rules in this part are made 

applicable also to the approval of suppliers that meet the requirements 

specified in Sec. 489.13.

    (e) Section 1861(o)(7) of the Act requires each HHA to provide CMS 

with a surety bond.



[45 FR 22937, Apr. 4, 1980, as amended at 51 FR 24492, July 3, 1986; 62 

FR 43936, Aug. 18, 1997; 63 FR 312, Jan. 5, 1998]