[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: 42CFR498.2]



[Page 1089-1090]

 

                         TITLE 42--PUBLIC HEALTH

 

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

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 498_APPEALS PROCEDURES FOR DETERMINATIONS THAT AFFECT PARTICIPATION 

IN THE MEDICARE PROGRAM AND FOR DETERMINATIONS THAT AFFECT THE 

PARTICIPATION OF ICFs/MR AND CERTAIN NFs IN THE MEDICAID PROGRAM--Table 

of Contents

 

                      Subpart A_General Provisions

 

Sec. 498.2  Definitions.



    As used in this part--

    Affected party means a provider, prospective provider, supplier, 

prospective



[[Page 1090]]



supplier, or practitioner that is affected by an initial determination 

or by any subsequent determination or decision issued under this part, 

and ``party'' means the affected party or CMS (or the OIG), as 

appropriate.

    ALJ stands for Administrative Law Judge.

    Departmental Appeals Board or Board means a Board established in the 

Office of the Secretary to provide impartial review of disputed 

decisions made by the operating components of the Department.

    OHA stands for the Social Security Administration's Office of 

Hearings and Appeals.

    OIG stands for the Department's Office of the Inspector General.

    Provider means a hospital, critical access hospital (CAH), skilled 

nursing facility (SNF), comprehensive outpatient rehabilitation facility 

(CORF), home health agency (HHA), hospice, or religious nonmedical 

health care institution (RNHCI) that has in effect an agreement to 

participate in Medicare, that has in effect an agreement to participate 

in Medicaid, or a clinic, rehabilitation agency, or public health agency 

that has a similar agreement but only to furnish outpatient physical 

therapy or outpatient speech pathology services, and prospective 

provider means any of the listed entities that seeks to participate in 

Medicare as a provider or to have any facility or organization 

determined to be a department of the provider or provider-based entity 

under Sec. 413.65 of this chapter.

    Supplier means an independent laboratory, supplier of portable X-ray 

services, rural health clinic (RHC), Federally qualified health center 

(FQHC), ambulatory surgical center (ASC), organ procurement organization 

(OPO), an entity approved by CMS to furnish outpatient diabetes self-

management training, or end-stage renal disease (ESRD) treatment 

facility that is approved by CMS as meeting the conditions for coverage 

of its services, and prospective supplier means any of the listed 

entities that seeks to be approved for coverage of its services under 

Medicare. (However, for purposes of the sanctions and penalties that may 

be imposed by the OIG, the term supplier has the meaning specified in 

Sec. 1001.2 of this title.)



[52 FR 22446, June 12, 1987, as amended at 53 FR 6551, March 1, 1988; 57 

FR 24984, June 12, 1992; 58 FR 30677, May 26, 1993; 59 FR 6579, Feb. 11, 

1994; 59 FR 56251, Nov. 10, 1994; 61 FR 32350, June 24, 1996; 62 FR 

46037, Aug. 29, 1997; 65 FR 18549, Apr. 7, 2000; 65 FR 83154, Dec. 29, 

2000; 68 FR 66721, Nov. 28, 2003]