[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

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

[CITE: 42CFR1000.10]



[Page 1119-1120]

 

                         TITLE 42--PUBLIC HEALTH

 

      GENERAL--HEALTH CARE, DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

PART 1000_INTRODUCTION; GENERAL DEFINITIONS--Table of Contents

 

                          Subpart B_Definitions

 

Sec.  1000.10  General definitions.





    In this chapter, unless the context indicates otherwise--

    Act means the Social Security Act, and titles referred to are titles 

of that Act.

    Administrator means the Administrator, Centers for Medicare & 

Medicaid Services (CMS), formerly the Health Care Financing 

Administration (HCFA).

    Beneficiary means any individual eligible to have benefits paid to 

him or her, or on his or her behalf, under Medicare or any State health 

care program.

    CFR stands for Code of Federal Regulations.

    CMS stands for Centers for Medicare & Medicaid Services, formerly 

the Health Care Financing Administration (HCFA).

    Department means the Department of Health and Human Services (HHS), 

formerly the Department of Health, Education, and Welfare.

    Directly, as used in the definition of ``furnished'' in this 

section, means the provision of items and services by individuals or 

entities (including items and services provided by them, but 

manufactured, ordered or prescribed by another individual or entity) who 

submit claims to Medicare, Medicaid or other Federal health care 

programs.

    ESRD stands for end-stage renal disease.

    FR stands for Federal Register.

    Furnished refers to items or services provided or supplied, directly 

or indirectly, by any individual or entity. This includes items and 

services manufactured, distributed or otherwise provided by individuals 

or entities that do not directly submit claims to Medicare, Medicaid or 

other Federal health care programs, but that supply items or services to 

providers, practitioners or suppliers who submit claims to these 

programs for such items or services.

    HHS stands for the Department of Health and Human Services.

    HHA stands for home health agency.

    HMO stands for health maintenance organization.

    ICF stands for intermediate care facility.

    Indirectly, as used in the definition of ``furnished'' in this 

section, means the provision of items and services manufactured, 

distributed or otherwise supplied by individuals or entities who do not 

directly submit claims to Medicare, Medicaid or other Federal health 

care programs, but that provide items and services to providers, 

practitioners or suppliers who submit claims to these programs for such 

items and services. This term does not include individuals and entities 

that submit claims directly to these programs for items and services 

ordered or prescribed by another individual or entity.

    Inspector General means the Inspector General for Health and Human 

Services.

    Medicaid means medical assistance provided under a State plan 

approved under Title XIX of the Act.

    Medicare means the health insurance program for the aged and 

disabled under Title XVIII of the Act.

    OIG means the Office of Inspector General within HHS.

    QIO stands for Utilization and Quality Control Quality Improvement 

Organization.

    Secretary means the Secretary of Health and Human Services.



[[Page 1120]]



    SNF stands for skilled nursing facility.

    Social security benefits means monthly cash benefits payable under 

section 202 or 223 of the Act.

    SSA stands for Social Security Administration.

    United States means the fifty States, the District of Columbia, the 

Commonwealth of Puerto Rico, the Virgin Islands, Guam, American Samoa, 

and the Northern Mariana Islands.

    U.S.C. stands for United States Code.



[51 FR 34766, Sept. 30, 1986 as amended at 57 FR 3329, Jan. 29, 1992; 63 

FR 46685, Sept. 2, 1998; 66 FR 39452, July 31, 2001]